Low anterior resection syndrome after rectal cancer surgery: mechanisms, assessment, management, and the potential role of robotic surgery

Rectal cancer is one of the most commonly diagnosed malignancies in the digestive system. In recent years, with continuous advances in systemic therapies such as chemotherapy and radiotherapy, as well as the widespread implementation of the multidisciplinary team (MDT) approach, the prognosis for rectal cancer patients has seen substantial improvement. Radical surgical resection, guided by the principle of total mesorectal excision (TME), still forms the foundation of rectal cancer treatment. Recently, the da Vinci surgical robotic system, owing to its high-definition three-dimensional visualization, multi-degree-of-freedom articulated instruments, and stable, flexible camera platform, has been increasingly adopted in radical rectal cancer surgery. With this technological advancement, sphincter preservation has become feasible for a greater proportion of low rectal cancer patients, thereby sphincter-preserving surgery has become feasible for a greater proportion of patients with low rectal cancer. However, the increasing use of sphincter-preserving surgery has been accompanied by a rising incidence of postoperative functional disorders, most notably low anterior resection syndrome (LARS). A combination of symptoms, including increased bowel frequency, urgency, fecal incontinence, and evacuation problems, defines LARS, leading to significant disruptions in bowel function, psychological health, and quality of life. The mechanisms underlying LARS remain incompletely understood. To prevent or alleviate the occurrence of LARS, enhance postoperative bowel function, and improve the quality of life in patients following low anterior resection for rectal cancer, this review summarizes recent advances in rectal cancer-related treatments and provides an overview of the current insights into the mechanisms, assessment, prevention, and management of LARS, aiming to provide evidence-based recommendations for clinical practice.