In advance of this month’s ESCP conference in Berlin, the annual gathering of coloproctology specialists from around Europe, we caught up with another of the key speakers - Professor Søren Laurberg from Aarhus University Hospital, Denmark.
Professor Laurberg will be sharing his expertise in the keynote lecture 'LARS - from bedside to bench and back' on Friday 22 September, the final morning of the increasingly influential event.
Prof Laurberg explains why this is an important area of focus:
“While there have been dramatic improvements in the outcomes of those who are treated for colorectal cancer in terms of a reduction in local recurrence and improved survival rates, there has been little focus on how patients are after we have cured them. This is about looking beyond cancer, looking at the long-term functional outcomes post-cancer and how functional problems should be treated.”
The main functional problem patients experience after having a restorative resection surgery for rectal cancer is Low Anterior Resection Syndrome, or LARS. It is estimated that 40-50% of patients treated with a resection for colorectal cancer will go on to have major LARS. For those treated with a low anastomosis combined with pre-operative radiotherapy this increases to over 80%.
“Despite this currently LARS is not officially recognised and treated. Given there is now a worldwide focus on the overall impact of cancer treatments on patients’ longer term wellbeing, now is the time to change that and address the situation. As can often be the case our studies have revealed that patients’ perspectives of such issues can differ from those of medical specialists,” explains Prof Laurberg.
A patient’s experience of LARS is that they have to rush to the toilet and then, when they go, they don’t know when they have finished. Then, often, they have to rush back to the toilet again. These patient experiences of post- surgical rectal dysfunction have recently been documented into a LARS score which a team led by Prof Laurberg’s colleague, Katrine Emmertsen, developed. The score is a combination of incontinence and, more importantly, urgency and clustering. This scoring system has since been validated in numerous studies worldwide.
The current understanding of the pathophysiology for major LARS is a combination of enhanced gastro-colic response after a meal, which is most likely due to denervation of the bowel at surgery, with a sensory loss in the pelvic cavity after irradiation – again during the cancer treatment journey. Prof Laurberg underlines that further studies are needed to confirm this.
Prof Laurberg contends that:
“Patients should be informed and involved in decisions about their treatment particularly because it is possible to predict the risk of major LARS before the surgical treatment of their colorectal cancer. More research is needed but it is entirely possible that the risk of patients experiencing LARS could be reduced by changing the treatment algorithm.”
“We must recognize major LARS by systematic use of the validated LARS score. It is possible to treat LARS but more research is needed to know the optimal treatment algorithm.”
This is an aspect of the colorectal specialism that is likely to see increasing focus, research and development. Given the majority of attendees at the ESCP Conference operate on cancer patients, it is definitely a must attend session to ensure they are at the forefront of the thinking on LARS and the next steps in treating it or indeed mitigating the risks of their patients suffering the consequences of the condition.
