LAR Syndrome and laparoscopic surgery, new paper on origins

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chrisca
Posts: 238
Joined: Wed Dec 07, 2011 10:35 pm
Location: Portland, Oregon

Re: LAR Syndrome and laparoscopic surgery, new paper on origins

Postby chrisca » Fri Nov 17, 2017 4:56 pm

Big Jay wrote:I did do watch and wait. At my one year scope we (I saw we because I stay awake for the flex sig) saw that something wasn't right. There was more fleshiness.. nodularity in medical terms... next to the scar that hadn't been there before. Biopsy came back as cancer. So, time to go back to the original plan for the TME. If it's coming back on the surface it may be coming back deeper into the muscle wall.

Sorry to hear about the recurrence but at 9 cm from the anal verge you're still at fairly low risk for LARS. Be sure your surgeon is willing and experienced at doing a low ligation of the IMA. That will give you the best chances at a good outcome.
Male, false negative colonoscopy age 48
DX: 12/2010 rectal cancer age 51
Stage T3N0M0 2 cm from anal verge
neoadjuvant rad/chemo Xeloda
Rectal resection (open surgery) straight anastomosis
Xeloda round 2
ileostomy reversal 11/2011
Successful adhesion X-lap 8/2013
Ongoing LAR syndrome but NED 7 years

lakeswim
Posts: 209
Joined: Sat Mar 31, 2018 9:37 am

Re: LAR Syndrome and laparoscopic surgery, new paper on origins

Postby lakeswim » Wed Jan 09, 2019 8:19 pm

chrisca wrote:I just had a visit with my GI doc. A new paper is out on LAR syndrome. While it doesn't provide any treatment breakthroughs, it gives encouraging news that researchers are homing in on the cause. It's at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991969/. A major cause appears to be loss of nerve connections along the inferior mesenteric artery (IMA). An interesting excerpt from the paper:
It is very likely that much of what is recognized as LAR syndrome is actually related to what happens to the autonomic innervation of the neorectum during the course of the extensive mobilization that occurs during a LAR. The authors have observed in the operating room that after the complete mobilization and division of bowel required as part of a LAR (in preparation for a coloanal anastomosis), there are very strong contractions that randomly take place in the distal transverse and descending colon: they never start or progress into the mid- or proximal transverse colon. We have hypothesized that the disordered bowel function, known as LAR syndrome, is a result of motility changes seen in the left colon following extrinsic denervation that occurs with the extensive mobilization performed during these operations.

My GI doc mentioned that with the increasing popularity of laparoscopic procedures for rectal resection, very high ligation of the IMA is usually done. This is the worst possible scenario for LAR syndrome risk.

Anyone contemplating laparoscopic rectal resection should be aware of this risk and ask the surgeon about how the IMA ligation will be done. While laparoscopic surgery has a quicker recovery, it could leave one with lifelong consequences that might not happen if it's possible to choose open surgery and low ligation of the IMA. Whether that is possible or not depends on a number of factors, and can only be determined for certain during the procedure. But be informed, and discuss the risks with your doctor beforehand.


I apologize. I have no comment on this (right now) - but just wanted to save this thread and I don't know how to save it otherwise. Thanks for understanding.
50 - F - Mom
RC - dgns 3/18 at age 49
Adenocarcinoma
10-11 cm frm anal verge ("large")
Stage 3a - T4N0M0
FOLFOX May -Sept '18
Capecetabine + Radiation - 28 sessions - Oct - Nov 2018
Jan 19 - MRI & flex sig show tumor gone
Mid-Feb 19 - MRI & flex sig show tumor gone
W&W


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