The first Dutch experience with a nurse-led outpatient clinic for the prevention and treatment of LARS after colorectal surgery - promising results of a standardized treatment protocol

Q: What patient problem does the nurse-led clinic target after colorectal surgery?

The clinic targets low anterior resection syndrome (LARS), a persistent functional bowel disorder after sphincter-preserving colorectal surgery, with an emphasis on early detection and management.

Q: How was treatment delivered in the standardized protocol?

A nurse-led component supported a structured five-phase protocol, starting with preoperative counseling and conservative management, progressing through multidisciplinary care, and using invasive interventions when necessary.

Q: Which outcomes were measured to assess effectiveness?

Bowel function and quality of life were assessed before and after treatment using validated instruments including the LARS score, Wexner score, and EORTC QLQ-C30 and QLQ-C29 questionnaires.

Sep 30, 2026

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A retrospective observational study evaluated quality of life and functional outcomes in patients with colorectal disease treated in a multidisciplinary, nurse-led low anterior resection syndrome (LARS) outpatient clinic after surgery. Between January 2021 and December 2024, a standardized five-phase protocol with nurse-led early symptom detection and structured follow-up guided conservative to multidisciplinary, and when needed invasive, interventions. Outcomes used validated LARS, Wexner, and EORTC QLQ-C30/QLQ-C29 instruments before and after treatment.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Purpose

Methods

Results

Conclusions

Introduction

Background on LARS

Rationale for a nurse-led standardized protocol

Study aim and outcomes

Techniques in Coloproctology (2026) 30:13 [https://doi.org/10.1007/s10151-025-03250-z](https://doi.org/10.1007/s10151-025-03250-z) The first Dutch experience with a nurse‑led outpatient clinic for the prevention and treatment of LARS after colorectal surgery: promising results of a standardized treatment protocol C. Smit1,2 · M. L. Janssen‑Heijnen3,4 · F. van Osch3,4 · M. van Heinsbergen1 · J. L. M. Konsten1 Received: 10 June 2025 / Accepted: 2 November 2025 © The Author(s) 2025 Abstract Purpose To report the quality of life (QoL) and functional outcomes in patients with colorectal disease after receiving treatment in a multidisciplinary, nurse-led low anterior resection syndrome (LARS) outpatient clinic post surgery. Methods A retrospective observational study was conducted that included all patients with colorectal disease referred to the LARS outpatient clinic at VieCuri Medical Centre between January 2021 and December 2024. A standardized treatment protocol was implemented, complemented by a nurse-led component that enabled early symptom detection and provided accessible, intensive patient contact and follow-up. The structured five-phase protocol ranges from preoperative counseling and conservative management to multidisciplinary care and, if necessary, invasive interventions. Bowel function and quality of life were assessed pre-and post-treatment using validated instruments, including the LARS score, Wexner score, and the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-C29 questionnaires. Results A total of 96 patients were included. Median LARS scores decreased from 38.0 to 13.0 (p < 0.001), with 76% of patients transitioning from major to no LARS. Wexner scores improved from 11.0 to 2.0 (p < 0.001), and global QoL increased from 66.7 to 83.3 (p < 0.001) . Pharmacological treatment was administered to 93% of patients, most commonly psyllium and loperamide. In addition, 85% were referred to a dietitian, 50% to pelvic floor physiotherapy, and 26% to a psychologist or sexologist. Transanal irrigation was introduced in 14% of cases. Only one patient required sacral neuromodulation, and one opted for a permanent stoma. The median follow-up consisted of three in-person and three telephone consultations per patient. Conclusions A multidisciplinary, nurse-led LARS clinic significantly improved bowel function and QoL in patients with colorectal cancer (CRC) . These findings support the implementation of structured, individualized care pathways for LARS management. Keywords Low anterior resection syndrome · Colorectal cancer · Bowel dysfunction · Nurse-led care · Quality of life · Multidisciplinary approach * C. Smit [csmit@viecuri.nl](csmit@viecuri.nl) 1 Department of Surgery, VieCuri Medical Centre, Tegelseweg 210, 5912 BL Venlo, The Netherlands 2 GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands 3 Department of Clinical Epidemiology, VieCuri Medical Centre, 5912 BL Venlo, The Netherlands 4 Department of Epidemiology, GROW Research Institute for Oncology & Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands Introduction Low anterior resection syndrome (LARS) is a debilitating condition characterized by persistent functional bowel disorders following sphincter-preserving surgery in patients with colorectal cancer [1] . This syndrome significantly impacts patients’ quality of life, with reported prevalence rates ranging from 76% to 90% among individuals undergoing rectal cancer surgery [2–4]. Notably, there is a growing recognition of LARS-like symptoms in patients following other types of colorectal surgery, such as sigmoid resections [5] . The heterogeneous clinical presentation of LARS poses a significant challenge in establishing a universally effective therapeutic approach. As a result, the management of LARS remains complex and multifaceted, often requiring

FAQs

What patient problem does the nurse-led clinic target after colorectal surgery?

The clinic targets low anterior resection syndrome (LARS), a persistent functional bowel disorder after sphincter-preserving colorectal surgery, with an emphasis on early detection and management.

How was treatment delivered in the standardized protocol?

A nurse-led component supported a structured five-phase protocol, starting with preoperative counseling and conservative management, progressing through multidisciplinary care, and using invasive interventions when necessary.

Which outcomes were measured to assess effectiveness?

Bowel function and quality of life were assessed before and after treatment using validated instruments including the LARS score, Wexner score, and EORTC QLQ-C30 and QLQ-C29 questionnaires.

Sep 30, 2026

Upload by Levi