Role of surgical approach on LARS: LAR vs. TEM, TAMIS, transanal excision, TaTME

Abstract Despite advances in surgical techniques, low anterior resection syndrome (LARS) is common in patients after surgery for rectal adenocarcinoma. Fecal incontinence, urgency, and incomplete evacuation are frequent complaints. Anorectal function can be assessed by dynamic magnetic resonance imaging (MRI), anorectal manometry, and by several assessment tools including the LARS score. Despite their different approach to the pelvic dissection, both transabdominal low anterior resection (LAR) and transanal total mesorectal excision (TaTME) share a similar prevalence of LARS after surgery. Data regarding functional outcomes after transanal techniques are lacking, but the functional results seem to be favorable when compared to proctectomy. Pre-operative evaluation of anorectal function is recommended to provide a better estimate of functional outcomes post-operatively and to provide tailored recommendations for restorative versus non-restorative surgery.