Editorial: Low Anterior Resection Syndrome - Treatment Possibilities

Michail Klimovskij ^1* Audrius Dulskas ²

• ¹ East Sussex Healthcare NHS Trust, Saint Leonards-on-Sea, United Kingdom
• ² National Cancer Institute (Lithuania), Vilnius, Lithuania

If you ask ChatGPT to tell you about LARS, you will get quite a thorough answer about etymology and origin of a Scandinavian name. It is a good reflection in perception and common knowledge about low anterior resection syndrome, although being anecdotical. As a specialist you encounter much controversy surrounding this syndrome, not to mention the health professional who is not regularly dealing with such cluster of patients as well as the patients themselves with the society understanding.And if not to create a universal programme to educate the public sector with LARS abbreviation and what stands behind it, the vision of this research project is to highlight the controversies, assumptions and challenges dealing with low anterior resection syndrome. In the light of evolution of surgery prioritising minimally invasive approach, introducing and developing robotics in colorectal field, rectum sparing operations now are a standard of what would have been classic old school Hartmann’s or abdominoperineal resection not long time ago. It brings a degree of stigmatised anticipated quality of life without having a ‘stoma bag’, however, as a downside all this cohort of patients has a tendency of developing a degree of LARS.The primary aim of this Research Topic was getting the deeper understanding of LARS, with a specific emphasis on exploring new etiological theories and potential surgical treatments. Interest was focused on clinical studies that shed light on various aspects related to this syndrome, including the efficiency of different treatment modalities and their impact on patients' quality of life.Part of our research was to focus on the studies or papers aiming to review the prediction of LARS. There is a space for predictive models as POLARS and relevance of the outcomes predicted comparing to the observed, paper is on the way focused on comparing of multicentre results of postoperative LARS with POLARS scores. The scores, however, have shown limitations of capturing the LARS cohort of patients comparing to LARS definitions suggested in International consensus definition of low anterior resection syndrome in 2020. Known assumptions, such as lower the tumour the worse the function, neoadjuvant treatment – radiotherapy to pelvis, ileostomy and timing of its closure are basic components of prognostic factors developing low anterior resection syndrome, predictive modelling was demonstrated in a paper: (Prediction model construction for the occurrence of LARS after neoadjuvant therapy combined with laparoscopic total mesorectal excision in male patients with mid-low rectal cancer).Keeping it simple, all pathologies in a healthcare setting are getting coded to get systemised, allowing health statistical algorithms to work as well as economical aspects to follow. Surprisingly, LARS has no place as an ICD pathological unit to get recognised; this problem is reflected in the paper attached: (Coding the issue: low anterior resection syndrome following rectal cancer treatment).One of the important factors of low anterior resection syndrome (LARS) treatment is self-management, which requires patient engagement. Colorectal surgeons and nurses may use patient-generated health data (PGHD) to help guide patients in their use of self-management strategies for LARS. However, the perspectives of LARS experts on the use of PGHD remain largely unexplored. The study was included in our research topic which was aiming to explore the perspectives and experiences of LARS experts regarding the use of PGHD in the management of LARS. (The use of patient-generated health data in the management of low anterior resection syndrome: a qualitative study)Moving forward, the treatment of LARS has no unified approach. There are different modalities treating this complex etiologically and pathogenetically not exactly fully agreed syndrome. Need to mention POLARiS Pathway Of Low Anterior Resection syndrome relief after Surgery trial, focusing To evaluate the clinical and cost-effectiveness of Transanal irrigation (TAI) or Sacral neuromodulation (SNM) versus optimised conservative management (OCM) for people with major LARS. Part of our research was to review pathways of algorithms of studies to learn from the results of different management options, for example transanal irrigation study included in this research topic: (Is transanal irrigation the best treatment possibility for low anterior resection syndrome? A multicenter, randomized clinical trial: study protocol)Conclusions of our research would remain as an open discussion for everyone interested. The interest is valid with the fact that the number of LARS patients is increasing. It is important for the patients to speak up and seek for help knowing that this syndrome is recognised, anticipated in some way and treated accordingly.It is important for health care professionals to know that such syndrome exists and if not to be able to treat it or knowing basic principles of its treatment – the intention would be to identify the patient with further referral to appropriate specialist.Where we are with LARS today? Great question to answer and look around. The aim of our research is to raise the awareness of this syndrome with focus on further interest on deep learning, investment, project activity coming up with formalised guidelines on diagnosis, management and overall recognition of LARS.Hope it will make a change.