Authors (including presenting author) :
Lee WS(1), Wong MK(1), Lee KY(1), Kwok SY(1), Yeung YK(2), Ng SW(2), Lo HY(2), Fung KY(2)
Affiliation :
(1) Department of Surgery, Kwong Wah Hospital
(2) Department of Physiotherapy, Kwong Wah Hospital
Introduction :
Colorectal cancer became the third most common cancer in Hong Kong and worldwide in 2022. Low Anterior Resection(LAR) with Total Mesorectal Excision (TME) for mid and low rectal cancer is the standard treatment for rectum cancer. However, up to 60% of patients suffer from bothersome functional bowel problem which is known as Low Anterior Resection Syndrome (LARS), symptoms including fecal urgency, incontinence, frequency, constipation and incomplete emptying. LARS has a negative impact on patient’s quality of life. A collaborative management program was launched and aim to improve patient bowel function and quality of life.
Objectives :
- To enhance patient education on treatment related bowel dysfunction
- To empower patient on bowel dysfunction management
- To strengthen patient’s pelvic floor muscles
Methodology :
All rectum cancer patients who undergoing for Low Anterior Resection will be recruited into this program. Patient’s bowel habit, incontinence history and anal tone will be assessed before surgery. Pre-operative education regarding the surgery and related potential risk of bowel dysfunction, pelvic floor muscle exercise will be instructed. Patients were reminded to perform pelvic floor exercise regularly before and after the surgery. After closure of stoma, patient will be assessed by nurse and physiotherapist. Dietary modification, perianal skin care, bowel management, pelvic floor exercise and defecation posture were instructed. Patients were scheduled visit every month for 6 months.
Result & Outcome :
From 2022 to 2023, 21 patients (M= 13, mean age 66.6; F=8, mean age 59) who had received Low Anterior Resection with closure of stoma were completed the program, bowel symptom, quality of life and LARS score were assessed. No LARS (4.8%), Minor LARS (28.5%), Major LARS (66.7%) were found on post closure 1 months. After 6 month’s intervention, 85.7% of Major LARS patient has improvement on bowel function, from Major LARS decline to Minor LARS and No LARS.
The Collaborative management program was demonstrated effective to improve bowel function after low anterior resection. Although there is no standard treatment strategy for patient with LARS, this service model provides a new direction to improve patient outcome.
