BACKGROUND: Low anterior resection syndrome (LARS) following sphincter-preserving surgery for rectal cancer has a high prevalence, with an impact on long term bowel dysfunction and quality of life. We designed the BOwel REhAbiLitation program (BOREAL) as a proactive strategy to assess and treat patients with LARS. The BOREAL program consists of a stepwise approach of escalating treatments; medical management (Step 0-1), pelvic floor physiotherapy, biofeedback and transanal irrigation (Step 2), sacral nerve neuromodulation (Step 3), percutaneous endoscopic caecostomy and anterograde enema (Step 4) and definitive colostomy (Step 5). METHODS: A pilot study was undertaken to assess the feasibility of collecting LARS data routinely with the parallel implementation of the BOREAL program. All patients who underwent total mesorectal excision for rectal cancer between February 2017 and March 2019 were included. LARS was assessed using the LARS score and the Wexner Faecal Incontinence Score at 30 days and 3, 6, 9 and 12 months post-operatively. A good functional result was considered to be a combined LARS score < 20 and/or a Wexner score <4. RESULTS: 137 patients were included. Overall compliance with the BOREAL program was 72.9%. Major LARS decreased from 48% at 30 days post-operatively to 12% at 12 months, with a concomitant improvement in overall good function from 33% to 77%, p<0.001. The majority of patients (n=106, 77%) required medical management of their LARS. CONCLUSION: The BOREAL program demonstrates the acceptability, feasibility and effectiveness of implementing a responsive, stepwise program for detecting and treating LARS. This article is protected by copyright. All rights reserved.
BACKGROUND: Low anterior resection syndrome (LARS) following sphincter-preserving surgery for rectal cancer has a high prevalence, with an impact on long term bowel dysfunction and quality of life. We designed the BOwel REhAbiLitation program (BOREAL) as a proactive strategy to assess and treat patients with LARS. The BOREAL program consists of a stepwise approach of escalating treatments; medical management (Step 0-1), pelvic floor physiotherapy, biofeedback and transanal irrigation (Step 2), sacral nerve neuromodulation (Step 3), percutaneous endoscopic caecostomy and anterograde enema (Step 4) and definitive colostomy (Step 5). METHODS: A pilot study was undertaken to assess the feasibility of collecting LARS data routinely with the parallel implementation of the BOREAL program. All patients who underwent total mesorectal excision for rectal cancer between February 2017 and March 2019 were included. LARS was assessed using the LARS score and the Wexner Faecal Incontinence Score at 30 days and 3, 6, 9 and 12 months post-operatively. A good functional result was considered to be a combined LARS score < 20 and/or a Wexner score <4. RESULTS: 137 patients were included. Overall compliance with the BOREAL program was 72.9%. Major LARS decreased from 48% at 30 days post-operatively to 12% at 12 months, with a concomitant improvement in overall good function from 33% to 77%, p<0.001. The majority of patients (n=106, 77%) required medical management of their LARS. CONCLUSION: The BOREAL program demonstrates the acceptability, feasibility and effectiveness of implementing a responsive, stepwise program for detecting and treating LARS. This article is protected by copyright. All rights reserved.
Authors: Anne Asnong; André D'Hoore; Marijke Van Kampen; Albert Wolthuis; Yves Van Molhem; Bart Van Geluwe; Nele Devoogdt; An De Groef; Ipek Guler Caamano Fajardo; Inge Geraerts Journal: Ann Surg Date: 2022-07-27 Impact factor: 13.787