To assess the current status of knowledge, attitudes, and practices (KAP) related to Low Anterior Resection Syndrome (LARS) prevention among rectal cancer patients with prophylactic stomas. A multicenter cross-sectional study was conducted. A cross-sectional survey was administered to 206 patients who underwent prophylactic stoma reversal after sphincter saving rectal cancer surgery at 20 tertiary hospitals in a specific region between January 2024 and January 2025. A validated KAP questionnaire was utilized, comprising three domains: knowledge (12 items), attitudes (10 items), and practices (10 items). Data analysis included descriptive statistics, univariate analysis, multiple linear regression, and mediation analysis. The total KAP score was 109.39 (20.29) (maximum: 160), with sub-scores of 38.46 (8.46) (knowledge), 40.02 (4.25) (attitudes), and 30.92 (10.59) (practices). Educational level, residence, and primary caregiver were identified as significant explanatory factors in multiple linear regression analysis of KAP scores (all p < 0.05). Attitudes partially mediated the relationship between knowledge and practice (mediation effect: 24.90%, p < 0.05). Despite positive attitudes, patients demonstrated moderate knowledge gaps and suboptimal behavioral compliance. Patients contributed data to this study but were not involved in its design, analysis, or reporting.
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[This corrects the article DOI: 10.1183/23120541.00970-2025.].
Background: Low anterior resection syndrome (LARS) is a frequent survivorship problem after sphincter-preserving rectal cancer surgery. Pelvic radiotherapy (RT), often combined with chemotherapy, is frequently implicated in LARS development, but its apparent effect may be confounded by low tumor location and diversion. We evaluated whether RT (±chemotherapy) separates the risk of postoperative LARS severity-especially major LARS-beyond classical anatomic and pathway determinants. Methods: We conducted a single-centre observational cohort study of operated rectal cancer patients managed between 2013 and 2024, who completed the Romanian-validated LARS score by standardized telephone interview after restoration of bowel continuity (up to 18 months postoperatively). Outcomes were postoperative LARS score, LARS category, and major LARS. Comparisons were performed by RT status and by oncologic treatment pattern. Multivariable logistic regression assessed associations with major LARS, adjusting a priori for tumor location and diverting ileostomy; furthermore, extended sensitivity models incorporated technical/pathway variables. Discrimination was explored using 5-fold cross-validated ROC/AUC. Item-level LARS responses were analyzed to characterize symptom phenotype. Results: Overall, 182 patients were included (RT: 106; no RT: 76); 43.4% had LARS (minor 14.8%, major 28.6%). RT-treated patients had higher postoperative LARS scores (median 21 vs. 12; p = 0.002) and a higher prevalence of major LARS (35.8% vs. 18.4%; p = 0.012). Across treatment patterns, LARS severity was highest in RT + chemotherapy. Item-level analyses indicated that RT-associated differences were driven mainly by urgency and clustering domains. In adjusted models, RT was not independently associated with major LARS, whereas low tumor location and diverting ileostomy were strong predictors. Discrimination for major LARS was modest: AUC 0.561 for RT alone, 0.643 for location + ileostomy, and 0.654 for location + ileostomy + RT (5-fold cross-validation). Conclusions: RT is associated with worse unadjusted postoperative bowel dysfunction after rectal cancer surgery and is linked to urgency/clustering-dominant symptom patterns. However, in this cohort, the risk of major LARS was predominantly explained by tumor location and diversion rather than RT alone, supporting integrated risk stratification and early symptom-directed survivorship care.
Aminoacyl-tRNA synthetases, as pivotal enzymes in protein biosynthesis, have been linked to the development of certain diseases when specific isoforms are dysregulated. However, the involvement of leucyl-tRNA synthetase (LARS) in hepatic pathologies remains unexplored. In this study, a marked upregulation of LARS was observed in cholestatic liver tissues. Mice with liver-specific LARS knockdown manifested substantially attenuated hepatic injury, evidenced by reductions in serum alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase levels, as well as dysregulated bile acid homoeostasis, diminished hepatic necrosis, fibrosis, and hepatocyte apoptosis. Conversely, hepatic overexpression of LARS resulted in exacerbated liver injury. To mimic cholestatic injury in vitro, AML-12 cells were exposed to taurocholic acid (TCA), where it was found that LARS deficiency alleviated TCA-induced cellular damage and apoptosis. Mechanistically, bile acids were found to induce an integrated stress response (ISR) via up-regulating the phosphorylation of general control nonderepressible (GCN) 2 levels. Notably, LARS deficiency was shown to attenuate the TCA-induced GCN2 phosphorylation upregulation, while no modulatory effect was detected on GCN2 expression in the absence of TCA. Furthermore, BDL decreased the hepatic leucine contents and tRNA cahrging ratio, which was reversed by LARS knockdown. GCN2 knockdown reversed the effect of LARS overexpression on AML-12 cell viability. Collectively, these findings delineate a regulatory role for LARS in modulating cholestatic liver injury, likely through the suppression of leucine-tRNA-GCN2 activation and ISR signaling pathway.
End-stage hypertrophic cardiomyopathy (HCM), defined as a left ventricular (LV) ejection fraction (LVEF) < 50%, is associated with poor prognosis; however, predictors of progression remain unclear. We aimed to identify prognostic factors for progression to end-stage HCM. We analyzed 925 patients with HCM between 2007 and 2023 who underwent ≥1 year of follow-up echocardiography. The primary outcome was progression to end-stage HCM, defined as an LVEF <50% without reversible causes. A CMR subcohort included 491 patients with baseline CMR. During a median follow-up of 6.5 years (IQR: 3.3-10.7), 35 patients (3.8%) progressed to end-stage HCM (10-year cumulative incidence: 4.4%, 95% CI: 2.5-6.2%). LVEF, LV apical aneurysm, and LARS were independent predictors of progression to end-stage HCM (per 1% decrease in LARS: adjusted HR 1.10, 95% CI 1.04-1.17, p < 0.001), and impaired LARS (<16.9%) was associated with a higher risk. In the CMR subcohort, LARS remained an independent predictor after adjusting for late gadolinium enhancement (LGE%) (adjusted HR 1.11, 95% CI 1.02-1.20, p = 0.011). Adding LARS to a model including LVEF, LV apical aneurysm, and LA size yielded significant incremental prognostic value (global χ2 27.1 to 40.1; p < 0.001). Similar incremental value was observed in models including LGE% in the CMR subcohort. After progression to end-stage HCM, prognosis was poor, with 2-year cardiovascular event-free survival rate of 71.0%. Progression to end-stage HCM is infrequent but associated with poor prognosis. Impaired LARS independently predicts disease progression beyond conventional markers, supporting its role in risk stratification.
Approximately 60-80% of rectal cancer patients develop low anterior resection syndrome (LARS) following sphincter-preserving surgery, which significantly impacts their quality of life. Existing treatments have various limitations. This case report evaluated the efficacy of electroacupuncture (EA) combined with moxibustion therapy for refractory LARS using a combined quantitative and qualitative approach. The patient was a 55-year-old man who continued to experience severe symptoms (LARS score: 34 points) 8 years after rectal cancer surgery, with sacral nerve modulation treatment proving ineffective. The patient received EA and moxibustion treatment between 5 December 2024 and 27 December 2024. EA was administered every other day (12 sessions total), targeting the bilateral sacral foramen acupoints: Shangliao (BL31), Ciliao (BL32), Zhongliao (BL33), and Xialiao (BL34). Electrical stimulation lasted 30 min per session with a continuous wave at 50 Hz. Daily moxibustion (23 sessions total) was applied to Shenshu (BL23) and Mingmen (DU4) to warm the kidneys and strengthen the yang. Moxa sticks (30 mm diameter) were held 2 cm above the skin for 45 min per session. After treatment, the LARS score decreased to 11. Daily defecation frequency reduced from 13-15 to 3-4 episodes. Qualitative interview results showed that urgency tolerance increased (from <1 min to 10 min), fecal leakage frequency decreased (from ≥1 daily to <1 weekly), and there was improvement in evacuation difficulties and flatus control. Systemic symptoms (cold extremities, abdominal distension) improved. However, therapeutic effects partially relapsed at 3 months and stabilized at minor LARS levels (score 24) through 1-year follow-up. By combining quantitative and qualitative outcome assessments, this case report offers initial evidence for short-term symptom management in refractory LARS. High-quality research is still needed to fully assess the efficacy of this treatment.
The Turnbull procedure (coloanal pull-through with delayed coloanal anastomosis, DCAA) serves as a salvage option for complex, therapy-refractory pelvic floor disorders to avoid permanent colostomy. This study evaluated the perioperative outcomes, stoma avoidance, and functional results of 16 patients treated between 2018 and 2024. A retrospective analysis of 16 consecutive patients with hostile pelvis (e.g., post-surgical fistulas, chronic pelvic sepsis, and Crohn's disease). The key outcomes were time to anastomosis, Clavien-Dindo complications, stoma reversal rate, SF-12 quality of life, LARS, and Wexner continence score. Follow-up = 19-80 months. Anastomosis occurred after a mean of 11 days (range, 6-19 days). Permanent stoma was avoided in 13/16 (81%) patients. Perioperative morbidity was low, and the SF-12 scores (14/16) ranged from 29 to 86%, correlating with the LARS (p = 0.016). In 12 patients, minor LARS was observed in 3/12, major LARS in 7/12, the Wexner incontinence score showed good continence in 4/12, moderate incontinence in 5/12, and severe incontinence in 3/12. The fistula subgroup showed the best functional results. The Turnbull/DCAA procedure enables sphincter preservation in complex pelvic disorders, particularly postoperative fistulas. Despite frequent major LARS and incontinence, 81% of the patients avoided permanent stoma. Meticulous selection and informed consent are essential because of the functional limitations.
Low anterior resection syndrome (LARS) is common after neoadjuvant chemoradiotherapy (nCRT) and sphincter-preserving surgery for rectal cancer and is associated with poor quality of life. However, reliable tools to identify patients at high risk remain limited. This study aims to develop and validate a prediction model for major LARS in patients with rectal cancer after nCRT and sphincter-preserving surgery. A total of 315 consecutive patients between 2019 and 2021 were retrospectively enrolled (training cohort: 213; independent validation cohort: 102). A distal resection margin collagen score (CSDRM) was derived from multiphoton imaging using least absolute shrinkage and selection operator (LASSO) logistic regression. A prediction nomogram incorporating CSDRM and clinicopathologic factors was developed and evaluated for discrimination, calibration, and clinical utility. The CSDRM was developed on the basis of eight features. Multivariable analysis revealed that the CSDRM (odds ratio [OR] 3.57, 95% confidence interval [CI] 2.56-5.37), tumor distance from the anal verge, and time to stoma closure were independent predictors of major LARS. The CSDRM-integrated nomogram showed good discrimination in the training cohort (area under the receiver operating characteristic curve [AUROC], 0.914, 95% CI 0.863-0.957) and validation cohort (AUROC 0.922, 95% CI 0.851-0.976). Compared with the traditional model, incorporating CSDRM significantly improved discrimination in both the training cohort (AUROC 0.914 versus 0.631; p < 0.001) and validation cohort (AUROC, 0.922 versus 0.619; p < 0.001). The CSDRM was associated with major LARS after nCRT and sphincter-preserving surgery. The CSDRM-integrated model may support postoperative risk stratification for major LARS in patients with rectal cancer.
The choice between low anterior resection (LAR) and abdominoperineal resection (APR) for low rectal cancer involves complex trade-offs between sphincter preservation and functional outcomes. This study aimed to compare overall quality of life (QoL), colorectal-specific symptoms, and functional outcomes between LAR and APR at ≥ 12 months post-surgery and to identify influencing factors. This single-center retrospective cohort study included patients who underwent LAR or APR for low rectal cancer (≤ 5 cm from the anal verge) between January 2019 and December 2023. Patients completed validated questionnaires 12-60 months post-surgery. Inverse probability of treatment weighting was employed to adjust for baseline imbalances. Out of 168 eligible patients, 142 (84.5%) completed assessments (LAR n = 78, APR n = 64). After adjustment, the mean global health status was 68.3 ± 18.5 for LAR versus 71.2 ± 16.8 for APR (adjusted mean difference -2.9, p = 0.302). Major low-anterior resection syndrome affected 44.9% of LAR patients, whereas 31.3% of APR patients reported poor stoma-related QoL. Sexual dysfunction was prevalent in both groups. Neoadjuvant chemoradiotherapy and tumor distance ≤ 3 cm predicted major LARS. LARS severity did not perfectly align with QoL impairment; 20.0% of patients with minor LARS reported poor QoL, whereas 22.9% with major LARS maintained good QoL. No clinically meaningful difference in overall QoL was observed between LAR and APR at long-term follow-up. However, procedure-specific challenges exist; major LARS affects nearly half of LAR patients, and one-third of APR patients report poor stoma-related QoL. These findings support individualized surgical decision-making based on patient priorities and risk factors.
Low anterior resection syndrome (LARS) is a common complication of rectal resections. This study aimed to identify the symptoms that patients perceive as most bothersome, compare the symptom patterns between the early and late postoperative phases, and assess the limitations of existing scoring systems in reflecting patient distress. A cross-sectional study was conducted with 82 patients who underwent sphincter-preserving rectal resection at the Aichi Medical University Hospital (2016-2024). A questionnaire including the LARS score, Cleveland Clinic Florida Fecal Incontinence Score (CCFIS), and original questions on bothersome symptoms and subjective severity (0-10 scale) were administered. The patients were classified into the early (≤ 2 years, n = 28) and late (> 2 years, n = 54) postoperative groups. Clustering was the most frequently reported symptom in both the early (67.9%) and late (51.9%) phases. The median CCFIS was lower in the late group (6 [0-18] vs. 3.5 [0-17], p = 0.045), while no significant differences were observed in LARS scores (33 [12-39] vs. 29.5 [0-36], p = 0.127) or subjective severity (4 [0-9] vs. 3 [0-10], p = 0.588). One-third of the patients with severe clustering were not classified as having "major LARS." Clustering, which is often underestimated by composite scores, remained the most distressing and persistent symptom, emphasizing the need for symptom-specific evaluation in LARS.
To identify clinicians' perceived challenges and barriers in the management of low anterior resection syndrome (LARS) through exploration of attitudes and decision-making practices around screening, diagnosis and management. Exploratory interpretive qualitative design. Semi-structured interviews were undertaken and a reflexive thematic qualitative analysis was conducted using an iterative-inductive approach. Eleven colorectal surgeons, six physiotherapists and three specialist nurses were interviewed. Data were grouped into four major themes and 13 sub-themes. Variation in clinician engagement with LARS was identified, with clinicians' knowledge, training and personal interest in managing patients raised by participants as contributing factors. An absence of standardized management pathways presented challenges in clinical practice with the lack of structured multidisciplinary approaches and referral pathways combined with a perceived lack of established treatment guidelines impacting on clinical decision-making. Inequities in access to specialist pelvic services and treatment were identified as systemic limitations which influence clinical decision-making in relation to clinical practice and implementation of patient care. The interpretation of the patient experience with LARS and perceptions of treatment acceptability were identified to influence clinical decision-making and demonstrated divergent perceptions of patient experience. This study identified several challenges in LARS management from a clinician's perspective. A lack of standardized treatment guidelines and pathways, limited treatment access, and inconsistent clinician engagement present challenges. Divergent perceptions of patient experience and treatment acceptability further complicate care. These findings highlight the urgent need to address these systemic limitations through enhanced surgeon education, standardized treatment/referral guidelines, improved patient resources and expanded access to multidisciplinary care.
Low anterior resection syndrome (LARS) is a common and often under-recognised consequence of sphincter-preserving rectal cancer surgery, encompassing a range of bowel symptoms including urgency, faecal incontinence, increased stool frequency, clustering and incomplete emptying. These symptoms can profoundly affect quality of life, dignity, emotional wellbeing and social participation, and may persist for years as part of long-term cancer survivorship. Transanal irrigation (TAI) is one evidence-based management option for patients with problematic LARS. Recent systematic reviews and randomised controlled trials suggest that it can significantly reduce LARS symptom scores and improve bowel predictability, with benefits demonstrated at 3, 6 and 12 months. However, early discontinuation remains a concern, often linked to technical difficulties, unmet expectations or insufficient follow-up. For nurses, TAI represents a supported clinical intervention rather than a technical procedure alone. Effective nursing care requires structured pre-treatment assessment, individualised patient education, practical training, expectation setting and planned follow-up. Nurses are central to identifying appropriate patients, supporting adherence, troubleshooting common problems and recognising when onward referral is required. This article explores the pathophysiology and impact of LARS, reviews the evidence for TAI, and sets out the nursing assessment, education and support required to deliver safe and effective care. It also considers quality-of-life outcomes, safety considerations, and the implications for practice within a broader multidisciplinary survivorship pathway.
Low Anterior Resection Syndrome (LARS) is a common and debilitating outcome of sphincter-preserving surgery for colorectal cancer, severely affecting quality of life. While pelvic floor rehabilitation (PFR) is recommended as a conservative treatment, access to structured care is limited. This study assessed the feasibility and acceptability of a structured, physiotherapist-led PFR programme in an Australian outpatient setting, and explored the within-person changes in bowel function and quality of life. A non-randomised, single-arm prospective study was conducted at Concord Repatriation General Hospital (Sydney, Australia) from September 2020 to April 2024. Colorectal cancer survivors with LARS (score > 20) and bowel continuity restored > 6 months previously were enrolled. The 10-week PFR programme included education, pelvic floor muscle training, rectal balloon biofeedback, and home exercises, with adaptations for telehealth due to COVID-19. Primary outcome was programme adherence. Secondary outcomes included bowel, bladder, and sexual function, quality of life, and anorectal physiology; measured at baseline, post-intervention (3 months) and follow-up (9 months). Fourteen participants (median age sixty-three; seven female) completed the programme (one dropout with non-clinical reason), with 100% attendance and high home exercise adherence (median completion 100%). Bowel function improved significantly (median LARS score reduction -13.0; p = 0.004), with 71.4% achieving meaningful change post-intervention and 63.6% at follow-up. Quality of life significantly improved on validated measures. Anorectal physiology showed increased anal pressures, sensory thresholds, and better defaecatory coordination. No adverse events were reported. A structured, physiotherapist-led PFR programme is feasible and acceptable for colorectal cancer survivors with LARS. While improvements in bowel function and quality of life were observed over time, these findings should be interpreted as exploratory. The hypothesis-generating findings support further evaluation of PFR in a controlled trial to evaluate effectiveness and inform integration into multidisciplinary survivorship care.
Low anterior resection syndrome (LARS) is a common functional problem after sphincter-preserving rectal cancer surgery and includes urgency, frequent bowel movements, clustering, and fecal incontinence. Diverting ileostomy may further disrupt the intestinal environment and alter the gut microbiota, potentially worsening bowel dysfunction after ileostomy closure. However, evidence remains limited on whether bowel stimulation with probiotics before ileostomy closure can improve postoperative bowel function and reduce LARS severity. This study aims to evaluate the safety, feasibility, and efficacy of probiotic bowel stimulation through the distal limb of a diverting ileostomy before ileostomy closure in patients with rectal cancer. This single-center randomized controlled trial will be conducted at Keimyung University Dongsan Medical Center, Republic of Korea. Eligible participants are adults aged 18-80 years with clinical stage II or III rectal adenocarcinoma who completed neoadjuvant chemoradiotherapy and underwent laparoscopic or robotic low anterior resection with total mesorectal excision and diverting ileostomy, and who are scheduled for elective ileostomy closure. Participants will be randomly assigned in a 1:1 ratio to receive either 250 mL of normal saline with 4 g of Lacidofil or 250 mL of normal saline alone via the distal limb of the ileostomy once daily for 2 weeks before closure. The primary outcome is the LARS score 3 months after ileostomy closure. Secondary outcomes include postoperative complications, bowel recovery, stool habits, laboratory findings, and length of hospital stay. Analyses will primarily follow the intention-to-treat principle. The study was approved by the Institutional Review Board of Keimyung University Dongsan Medical Center (DSMC-2024-03-016) and registered with the Clinical Research Information Service (KCT0011052). Recruitment is planned to begin in March 2026 and is expected to continue through March 2029. At the time of manuscript submission, the study is in the pre-enrollment stage, with no participants recruited and no data analysis performed. Results are expected to be published in 2029. This trial will provide prospective evidence on whether probiotic bowel stimulation before ileostomy closure is a safe and effective strategy for improving postoperative bowel function and alleviating LARS in patients undergoing rectal cancer surgery with diverting ileostomy.
Bowel dysfunction is a common and debilitating condition affecting patients with endometriosis. Despite the extent of surgery, symptoms may persist or arise, often overlapping with low anterior resection syndrome (LARS) or irritable bowel syndrome (IBS) typical features. This review aims to summarize the multifactorial pathophysiology and current therapeutic options for postoperative bowel dysfunction after endometriosis surgery. A structured narrative review was conducted through a comprehensive search for studies published between 2000 and 2025. Inclusion criteria focused on postoperative functional outcomes and treatments (medical, rehabilitative and interventional) effectiveness. The available evidence is limited and largely extrapolated from related conditions such as LARS and neurogenic bowel dysfunction. The complex pathophysiology of postoperative dysfunction involves preoperative visceral hypersensitivity, surgical disruption of pelvic autonomic nerves, reduced rectal compliance, and pelvic floor dyssynergia. While dietary interventions (e.g., low-FODMAP diet) and pharmacological treatments (laxatives, antidiarrheals, or neuromodulators) serve as first-line therapies, they are often insufficient for severe symptoms. Emerging evidence supports the use of transanal irrigation (TAI) for mechanical emptying and sacral neuromodulation (SNM) for refractory sensorimotor disorders. Functional rehabilitation, including pelvic floor physiotherapy and manual therapy, represents a further opportunity to influence specific symptoms. Postoperative bowel dysfunction in endometriosis management requires a transition from rigid treatment protocols to a multidisciplinary, symptom-oriented approach. The support of specialized nursing, physiotherapy, and advanced interventions like TAI and SNM is essential. Future prospective studies using standardized outcome measures are needed to better define these therapeutic pathways and improve patient quality of life.
To characterize the anatomic pattern of postoperative recurrence in rectal cancer and determine whether irradiation of the distal mesorectum is necessary during preoperative radiotherapy, thereby informing safe target-volume reduction. We retrospectively analyzed 2,530 patients with rectal cancer who underwent total mesorectal excision (TME) at our institution between 2006 and 2024, with protocolized postoperative follow-up. Survival was evaluated using Kaplan-Meier methods, and independent predictors were identified with Cox proportional hazards models. Recurrence topography was visualized using a registration-based, voxel-wise probabilistic atlas. We quantified the vertical distance from the caudal edge of each recurrence to the coccygeal tip plane. In sphincter-preserved patients, bowel function was assessed with the Low Anterior Resection Syndrome (LARS) score. In the overall cohort, pelvic-floor recurrence occurred in 0.75%; no pelvic-floor recurrence was observed in the high rectal subgroup. Pelvic-floor recurrence was rare, and no statistically significant difference in survival outcomes was observed; however, this comparison was limited by the small number of events. Independent predictors of recurrence included family history of non-colorectal malignancy, poor differentiation, surgical approach, pT4 stage, pN positivity, and M1 disease. Compared with open surgery, laparoscopic surgery was associated with a lower risk of recurrence. After excluding pelvic-floor, anastomotic, and visceral recurrences, the most caudal in-field recurrence in mid/high rectal cancer remained above the coccygeal tip (mid rectum: 56.88 mm [45.21-68.56]; high rectum: 64.18 mm [45.35-83.01]). Long-term bowel function was favorable: 125 patients (88.65%) had LARS scores ≤ 20, 6 (4.26%) had scores of 21-29, and 10 (7.09%) had scores ≥ 30. Pelvic-floor recurrence after rectal cancer surgery was rare in this cohort. The small number of events precluded a definitive survival analysis, and no statistically significant association with overall survival was detected (HR 0.986; 95% CI 0.139-7.018). In mid/high rectal cancer, the caudal boundary of in-field recurrence lies cranial to the coccygeal tip, suggesting limited benefit from routine distal mesorectal coverage. These anatomic recurrence data provide exploratory support for selective distal CTV de-escalation in mid/high rectal cancer, but prospective validation with treatment-plan-based dosimetric assessment is required before clinical implementation.
For most patients with non-metastatic anal squamous cell carcinoma (ASCC), chemoradiotherapy (CRT) is the standard treatment. Data on long-term health-related quality of life (HRQoL) following CRT are limited. This study evaluated HRQoL and functioning of patients with ASCC after CRT and compared outcomes with a normative population. In this cross-sectional cohort study, patient-reported outcome measures (PROMs) from the Prospective Dutch ColoRectal Cancer (PLCRC) cohort were linked to clinical data from the Netherlands Cancer Registry. Patients with stage I-III ASCC diagnosed between 2016 and 2025 who completed the EORTC-QLQ-C30, EORTC-QLQ-CR29, Low Anterior Resection Syndrome (LARS) and/or Stoma Quality of Life (SQOLS) questionnaire ≥ 6 months after CRT were included. The C30 scores were compared to a sex-, age-, and comorbidity matched (1:3) Dutch normative population. A total of 72 patients were included (67% female; median age 65 years, 49% stage III). The median interval between end of CRT and C30 and CR29 questionnaire completion was 21.7 months. Compared with the normative population, patients reported lower overall HRQoL, lower functioning across all domains, and higher levels of fatigue and diarrhoea. Prominent CR29-reported symptoms included flatulence (mean 43.3), urinary frequency (mean 33.1), and embarrassment by defecation pattern (mean 31.8). Among patients without stoma, 62% (n = 32) reported major LARS. Patients with ASCC report reduced HRQoL after CRT compared to a normative population. These findings underscore the importance of post-treatment supportive care and insight into PROMs during routine follow-up may help tailor individualised guidance of patients.
Patient-reported quality-of-life (QoL) outcomes are increasingly recognized as relevant endpoints in elective colorectal surgery. However, the feasibility and interpretability of systematic QoL assessment after elective laparoscopic sigmoid resection for diverticular disease remain incompletely defined, particularly in single-center settings. This retrospective single-center pilot study analyzed consecutive patients undergoing elective laparoscopic sigmoid resection for diverticular disease. The primary objective was to assess the feasibility and completeness of postoperative QoL assessment using EQ-5D, GIQLI, and LARS questionnaires. Secondary objectives included perioperative outcomes and early postoperative morbidity. Clinical and operative data were analyzed descriptively. Thirty-six patients were included. Completion of postoperative QoL questionnaires was achieved in all cases. No floor or ceiling effects were observed across QoL instruments. Median postoperative length of stay was 7 (6-7) days. Minor postoperative complications (Clavien-Dindo <II) occurred in 8.4% of patients, with no major complications, anastomotic leaks, or reoperations. Mean EQ-5D and GIQLI scores indicated satisfactory early postoperative quality of life, while LARS scores suggested minimal bowel dysfunction. Systematic assessment of patient-reported outcomes after elective laparoscopic sigmoid resection for diverticular disease is feasible and yields interpretable early QoL signals. These pilot data support the integration of standardized QoL metrics in future prospective and comparative studies.
Sacral neuromodulation (SNM) is an established therapeutic option for fecal incontinence, low anterior resection syndrome (LARS), and selected bowel dysfunction phenotypes encountered in colorectal practice. Despite durable benefit in many patients, secondary loss of efficacy (LOE) remains a common long-term management problem and is often interpreted primarily through a mechanical lens. To refine a conceptual neurofunctional service model for LOE in SNM and to translate it into a more clinically applicable framework for coloproctological practice. For the purposes of this paper, LOE is defined as deterioration after a previously effective phase, operationalized by one or more of the following: loss of at least 50% of the initial clinically meaningful benefit; deterioration of five or more points on a validated symptom instrument (Wexner Continence Score, LARS Score, or equivalent), or documented worsening in a structured patient symptom diary; or sustained patient-reported decline over at least two consecutive assessments, after exclusion of technical failure. We propose a structured pathway comprising confirmation of LOE, systematic technical exclusion, minimum neurofunctional reassessment, phenotype-guided reprogramming, predefined reassessment intervals, and explicit thresholds for revision or explantation. Terms such as neuroadaptive drift and phenotype mismatch are presented as explanatory hypotheses rather than established mechanisms. Viewing SNM as a dynamic network-modulating therapy rather than a static device intervention may reduce unnecessary procedural escalation and improve the consistency of long-term management. The proposed model is intended as an implementable service framework for structured follow-up and reprogramming in patients with suspected LOE.