Low anterior resection

Low Anterior Resection (LAR) is a surgical procedure primarily used to treat rectal cancer located in the upper part of the rectum. This operation involves the removal of the cancerous section of the rectum and a portion of the sigmoid colon, followed by the reconnection of the remaining parts of the rectum and colon to preserve bowel function. The goal of LAR is to remove the tumor while maintaining the patient's ability to control bowel movements, thus avoiding the need for a permanent colostomy.

Indications

Low Anterior Resection is indicated for patients with rectal cancer that is located more than 5 cm from the anal verge, where the cancer has not spread to distant organs. It is also considered for high-grade dysplasia in the rectum. The decision to perform LAR depends on the tumor's size, location, and stage, as well as the patient's overall health and preference.

Procedure

The procedure can be performed using traditional open surgery or minimally invasive techniques such as laparoscopic surgery or robotic surgery. The choice of technique depends on the surgeon's expertise, the patient's condition, and the tumor's characteristics.

1. 1. 1. Steps:

1. The surgeon makes an incision in the abdomen (or several small incisions for laparoscopic or robotic approaches). 2. The diseased section of the rectum and a margin of healthy tissue are removed to ensure no cancer cells are left behind. 3. Lymph nodes near the rectum are also removed and examined for signs of cancer spread. 4. The remaining ends of the rectum and colon are then reconnected; this connection is known as an anastomosis. 5. In some cases, a temporary ileostomy may be created to allow the anastomosis to heal.

Postoperative Care

After surgery, patients are closely monitored and gradually return to a normal diet. Pain management, prevention of infection, and early mobilization are key aspects of postoperative care. Patients may also require physical therapy to regain full mobility and strength.

Complications

Complications from Low Anterior Resection can include anastomotic leak, infection, bleeding, and changes in bowel habits. Long-term issues may involve sexual dysfunction and urinary dysfunction, due to the proximity of the surgery site to nerves controlling these functions.

Outcomes

The success of Low Anterior Resection largely depends on the stage of the cancer at the time of surgery. Early-stage cancers have a higher likelihood of being completely removed, leading to better outcomes. The procedure also aims to preserve the quality of life by maintaining bowel function and avoiding a permanent colostomy.

Recovery

Recovery time varies; however, many patients can return to normal activities within 6 to 8 weeks post-surgery. Follow-up care is crucial to monitor for cancer recurrence and manage any long-term effects of the surgery.