The LARS score
After a sphincter-preserving resection for rectal cancer, many patients will develop severe bowel
dysfunction resulting in incontinence for flatus and/or faeces, urgency, fragmentation of stools and
frequent bowel movements. This combination of symptoms after low anterior resection is referred to as
Low Anterior Resection Syndrome (LARS) and can be associated with a negative impact on quality of life.
In order to be able to assess the functional outcome after surgery and to compare results from different
surgical approaches and from different studies, it is important that uniform terminology and scales are
used. We have developed a scoring system – the LARS Score based on symptoms and impact on quality of
life to evaluate bowel dysfunction after low anterior resection.
Use of the LARS score:
We recommend using the score at follow-up visits with all patients after a sphincter-preserving resection
for rectal cancer i.e. TME and PME. The score should be filled in by the patients either at home before
coming to the day clinic, or immediately after arrival. This way the results will be available for the
doctor/surgeon/nurse at the consultation.
The score can be used as a screening tool for bowel dysfunction and all patients should complete the score
regularly. A high score should lead to an exploration into whether the patient needs and wants help coping
with their bowel dysfunction.
Although no hard evidence exists within the field of treatment of LARS, all patients with major LARS should
be offered advice and conservative treatment to try to improve their function. In severe cases, bowel
irrigation could be tried.
Registration:
We recommend that the LARS score should be prospectively registered in both the patients’ charts and in a
registry to monitor the functional outcome of sphincter-preserving surgery.
Ref:
Emmertsen, KJ. and Laurberg S. “Low anterior resection syndrome score: development and validation of a
symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer” Ann
Surg. 2012;255(5):922-8
Juul T. et al: “International validation of the Low Anterior Resection Syndrome Score”. Ann Surg. 2014
Apr;259(4):728-34