Background: Low anterior resection syndrome (LARS) is a series of bowel dysfunction symptoms, including altered bowel frequency, irregular bowel rhythms, fecal incontinence, and constipation. LARS occurs in 80% of patients undergoing sphincter-preserving surgery, affecting patients’ quality of life along with social avoidance. Different measurements and treatments have been raised to deal with LARS, but no systematic standard has been developed. Objective and Methods: To promote the standardization of clinical trials and clinical management of LARS, this review summarizes the latest findings up until 2023 regarding the diagnostic criteria, assessment protocols, and treatment modalities for postoperative LARS in rectal cancer. Results: The diagnostic criteria for LARS need to be updated to the definition proposed by the LARS International Collaborative Group, replacing the current application of the LARS score. In both clinical trials and clinical treatment, the severity of LARS should be assessed using at least one symptom assessment questionnaire, the LARS score or MSKCC BFI, and at least one scale related to quality of life. Anorectal manometry, fecoflowmetry, endoscopic ultrasonography, and pelvic floor muscle strength testing are recommended to be adopted only in clinical trials. After analysis of the latest literature on LARS treatment, a stepwise classification model is established for the standardized clinical management of LARS. Patients with minor LARS can start with first-line treatment, including management of self-behavior with an emphasis on diet modification and medication. Lamosetron, colesevelam hydrochloride, and loperamide are common antidiarrheal agents. Second-line management indicates multi-mode pelvic floor rehabilitation and transanal irrigation. Patients with major LARS should select single or several treatments in second-line management. Refractory LARS can choose antegrade enema, neuromodulation, or colostomy. Conclusions: In clinical trials of LARS treatment between 2020 and 2022, the eligibility criteria and evaluation system have been variable. Therefore, it is urgent to create a standard for the diagnosis, assessment, and treatment of LARS. Failure to set placebos and differentiate subgroups are limitations of many current LARS studies. Randomized controlled trials comparing diverse therapies and long-term outcomes are absent, as well. Moreover, a new scale needs to be developed to incorporate the patient’s perspective and facilitate outpatient follow-up. Though the establishment of a stepwise classification model for LARS treatment here is indispensable, the refinement of the guidelines may be improved by more standardized studies.
背景：低位前切除综合征（LARS）是一系列肠道功能障碍症状，包括排便频率改变、排便节律紊乱、大便失禁及便秘等。在接受保肛手术的直肠癌患者中，约80%会出现LARS症状，严重影响患者生活质量并导致社会回避行为。目前已有多种评估方法和治疗方案被提出，但尚未形成系统化标准。目的与方法：为促进LARS临床试验与临床管理的规范化，本综述系统梳理截至2023年关于直肠癌术后LARS的诊断标准、评估方案及治疗模式的最新研究进展。结果：LARS诊断标准需更新为国际LARS协作组提出的定义，替代目前广泛使用的LARS评分。在临床试验和临床治疗中，应至少采用一种症状评估问卷（LARS评分或MSKCC BFI）结合一种生活质量量表进行严重程度评估。肛门直肠测压、粪流动力学检测、超声内镜及盆底肌力测试建议仅限于临床试验使用。通过对最新治疗文献的分析，建立了LARS阶梯式分级治疗模型：轻度LARS患者可从一线治疗开始，包括以饮食调整为核心的自我行为管理及药物治疗（常用止泻剂有拉莫司琼、盐酸考来维仑和洛哌丁胺）；二线管理涵盖多模式盆底康复训练和经肛门灌洗；重度LARS患者应直接选择单种或多种二线治疗方案；难治性LARS可选择顺行灌肠、神经调控或造口术。结论：2020-2022年间LARS治疗的临床试验在入组标准与评估体系方面存在显著差异，亟需建立统一的诊断、评估与治疗标准。当前多数研究存在未设置安慰剂对照、未进行亚组分析的局限性，同时缺乏不同疗法比较的随机对照试验及长期结局数据。未来需开发融合患者视角、便于门诊随访的新量表。虽然本研究建立的阶梯式治疗模型具有重要临床价值，但指南的完善仍需更多标准化研究支持。
肿瘤(癌症)患者之家