Intervention Pathways for Low Anterior Resection Syndrome after Sphincter-Saving Rectal Cancer Surgery: A Systematic Scoping Review.

An increased number of rectal cancer survivors are living with disordered bowel function, which is called low anterior resection syndrome. There is no gold standard in treatment so to manage their bowel function, patients search for strategies and compromises but rely mostly on trial and error. Several intervention pathways for LARS are suggested in the literature. The problem is that there is a great discrepancy between the treatment options within the pathway. This systematic scoping review aims to map the range of intervention pathways for LARS after sphincter-saving rectal cancer surgery. A systematic search was performed through four databases (CINAHL, EMBASE, PubMed, and Web of Science) plus exploration of reference lists of included papers. Any type of paper was included if it described an intervention pathway of bowel problems after sphincter-saving rectal cancer surgery. Exclusion criteria were absence of full paper, no intervention pathway, not being written in English or Dutch and patients with a stoma. A narrative synthesis of the results of included studies is presented. Of 373 identified papers, 12 were included in this scoping review. Despite similarities in treatment options there were variations in which treatments are included, when treatments should be instigated and even which patients should be treated. Treatment pathways included different steps (ranging from 2 to six) and different interventions (ranging from 5 to 9), commonly starting with conservative treatment and dietary alterations and ending with a discussion about stoma formation. Some intervention pathways also described preoperative and/or pre-stoma reversal interventions. There is no single definitive treatment pathway, and additionally, multimodal treatments are described. Nonetheless, guidance is necessary for HCPs and patients to ensure that appropriate care is provided. However, there is a lack of evidence to support many potentially useful interventions in a bowel symptom management pathway for people after rectal cancer surgery, particularly for conservative treatment. Additional work is necessary to determine how best to recognize, assess and address symptoms.