Recommendation ID

What is the effectiveness and safety of sacral nerve stimulation and transanal irrigation compared to symptomatic treatment for people with major low anterior resection syndrome?

Any explanatory notes
(if applicable)

Why the committee made the recommendations
Based on their experience, the committee agreed low anterior resection syndrome (LARS) can have a significant impact on a person's quality of life and daily functioning, so it is important to identify and treat it quickly. It is important that people who have had sphincter-preserving surgery are aware of its symptoms so they can seek help. Because LARS may only become apparent after discharge from hospital, it is important that it can be identified in primary care. LARS should be assessed using a validated tool, for example the LARS score, which is a validated patient-administered questionnaire.
No comparative evidence on different treatments for LARS was available, so the committee agreed based on their experience that people with LARS should be offered symptomatic treatment in primary care. The committee also agreed that if treatments offered in primary care have not helped, advice should be sought from secondary care to discuss further options and consider specialist input. Timing of this should be based on clinical judgement taking into consideration, for example, severity of symptoms and impact on quality of life.
Because of the lack of evidence on the effectiveness of treatments for LARS, a research recommendation was made to compare sacral nerve stimulation and transanal irrigation in people with LARS for whom conservative treatments have not worked.

How the recommendations might affect practice
Primary care clinicians are not necessarily aware of LARS or how to assess it, and administering the questionnaire might need extra work and time. However, it is patient-administered and easy to score and no training should be needed. Bowel dysfunction treatment for associated symptoms are commonly delivered in primary care, therefore, the recommendation is not expected to have a large impact on current practice in terms of number of patients and interventions, however, raising awareness of LARS will be needed among primary care professionals.
Full details of the evidence, the committee's discussion and the recommended approach to research are in evidence review E2: optimal management of low anterior resection syndrome.

Source guidance details

Comes from guidance
Colorectal cancer
Date issued
January 2020

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 31/01/2020