Improving Functional Outcomes and Quality of Life in Patients With Rectal Cancer After Surgery With Intensified Follow-up & Surveillance

NCT ID: NCT06936774

Last Updated: 2025-07-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

PHASE3

Total Enrollment

140 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-08-01

Study Completion Date

2028-07-01

Brief Summary

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The goal of this clinical study is to gain further insights into the treatment of patients with Low Anterior Resection Syndrome (LARS) symptoms after rectal resection. The main question is: Can LARS symptoms and quality of life be improved by implementing an intensified follow-up program? Researchers will compare the results of the intervention group with the results of a control group in which patients do not receive an intensified follow-up program to determine whether the intervention works. Participants will undergo an intensified follow-up program which consists of several follow-up visits and medical treatment, pelvic floor muscle training and gynaecological and urological co-treatment in case of LARS symptoms and urinary or sexual complaints.

Detailed Description

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Background: After surgical treatment of patients with rectal cancer, up to 65% experience a symptom complex known as LARS (Low Anterior Resection Syndrome). Those affected suffer from symptoms such as fecal incontinence, frequent bowel movements and a strong urge to defecate, which can severely impair their quality of life. Therapy options include treatment with medication such as bulking agents or drugs that reduce bowel motility, pelvic floor muscle training or stimulation of the nerves that control the function of the rectum and pelvic floor.

Objective: The aim of the present study is to investigate whether an intensified follow-up program can improve the LARS symptoms and consequently the quality of life of patients after rectal resection. If the planned study shows success of the program, we will be able to structurally improve the aftercare of those affected.

Methods: The study is being conducted at several centers in Switzerland, including St. Claraspital Basel. Patients who have had a rectal resection are recruited prior to the repositioning of the artificial bowel outlet, which was created during the primary operation, and randomly assigned to one of the both study groups (intensified follow-up or standard treatment). The symptoms are recorded using various questionnaires and patients will be treated according to our action plan. If LARS symptoms occur, patients receive drug treatment, pelvic floor physiotherapy and, if necessary, sacral neurostimulation, which means implanting a device which stimulates the nerves that control the function of the rectum and pelvic floor. If patients suffer from urinary problems or impaired sexual function they will be referred to our urology or gynecology department for further diagnosis and treatment.

Conditions

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LARS - Low Anterior Resection Syndrome Rectal Cancer Surgery Rectal Cancer Quality of Life (QOL)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Intervention group: Intensified follow-up program consisting of of several follow-up visits and medical treatment, pelvic floor muscle training and gynaecological and urological co-treatment in case of LARS symptoms and urinary or sexual complaints which will be recorded using questionnaires.

Control group: Treatment according to standard, recording of symptoms using questionnaires only at beginning and end of the study period.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Intervention group

Intensified follow-up program consisting of of several follow-up visits at 1, 4, 7 and 13 months and medical treatment, pelvic floor muscle training and gynaecological and urological co-treatment in case of LARS symptoms and urinary or sexual complaints which will be recorded using questionnaires.

Group Type EXPERIMENTAL

Intensified follow-up program

Intervention Type OTHER

The study intervention will be an intensified follow-up program which consists of different measures. Patients will attend follow-up visits 1, 4, 7 and 13 months after ileostomy repositioning, at which LARS symptoms, quality of life as well as sexual and urinary function will be recorded using various questionnaires. In case of LARS symptoms patients will receive medical treatment with loperamide and metamucil as well as pelvic floor muscle training (including biofeedback and home exercises). Regarding pelvic floor muscle training we are planning nine sessions instructed by physiotherapy staff. In case of therapy-resistant LARS symptoms after 6 months sacral neurostimulation is offered to the patients with a focus on incontinence symptoms and desire for surgery or transanal irrigation in patients with a focus on voiding disorders. In case of urinary and sexual complaints patients are referred to our urology or gynaecology department for further diagnostic and treatment.

Control group

Treatment according to standard guidelines, recording of symptoms using questionnaires at 1 and 13 months.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Intensified follow-up program

The study intervention will be an intensified follow-up program which consists of different measures. Patients will attend follow-up visits 1, 4, 7 and 13 months after ileostomy repositioning, at which LARS symptoms, quality of life as well as sexual and urinary function will be recorded using various questionnaires. In case of LARS symptoms patients will receive medical treatment with loperamide and metamucil as well as pelvic floor muscle training (including biofeedback and home exercises). Regarding pelvic floor muscle training we are planning nine sessions instructed by physiotherapy staff. In case of therapy-resistant LARS symptoms after 6 months sacral neurostimulation is offered to the patients with a focus on incontinence symptoms and desire for surgery or transanal irrigation in patients with a focus on voiding disorders. In case of urinary and sexual complaints patients are referred to our urology or gynaecology department for further diagnostic and treatment.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* patients older than 18 years
* patients with rectal cancer in the middle and lower third of the rectum in stages I to IV who underwent LAR with TME and protective ileostomy
* able to give informed consent as documented by signature

Exclusion Criteria

* dementia or other psychiatric disorder that would prevent the patients from answering the questionnaires and experiencing sustainable training effects
* impossibility of stoma reversal due to persistent anastomotic leak and/or local recurrence
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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St. Claraspital AG

OTHER

Sponsor Role collaborator

Clarunis - Universitäres Bauchzentrum Basel

OTHER

Sponsor Role collaborator

University Hospital, Basel, Switzerland

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Daniel Steinemann, Deputy chief physician

Role: STUDY_CHAIR

Clarunis - Universitäres Bauchzentrum Basel

Locations

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Clarunis Universitäres Bauchzentrum Basel

Basel, , Switzerland

Site Status

Lindenhofspital Bern

Bern, , Switzerland

Site Status

St. Anna Spital Bern

Bern, , Switzerland

Site Status

Kantonsspital Luzern

Lucerne, , Switzerland

Site Status

Kantonsspital Winterthur

Winterthur, , Switzerland

Site Status

Countries

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Switzerland

Central Contacts

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Felicitas Wiedemann, Resident

Role: CONTACT

+41 61 777 76 09

Marco von Strauss und Torney, Senior physician

Role: CONTACT

+41 61 777 7581

Facility Contacts

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Dominik Jakob

Role: primary

0041 31 632 59 00

local PI

Role: primary

Jörn Markus Gass

Role: primary

041 205 45 39

Benjamin Weixler

Role: primary

004152 266 20 40

References

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Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2012 May;255(5):922-8. doi: 10.1097/SLA.0b013e31824f1c21.

Reference Type BACKGROUND
PMID: 22504191 (View on PubMed)

Roberts RO, Jacobsen SJ, Jacobson DJ, Reilly WT, Talley NJ, Lieber MM. Natural history of prostatism: high American Urological Association Symptom scores among community-dwelling men and women with urinary incontinence. Urology. 1998 Feb;51(2):213-9. doi: 10.1016/s0090-4295(97)00505-0.

Reference Type BACKGROUND
PMID: 9495700 (View on PubMed)

Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999 Dec;11(6):319-26. doi: 10.1038/sj.ijir.3900472.

Reference Type BACKGROUND
PMID: 10637462 (View on PubMed)

Related Links

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https://qol.eortc.org/questionnaires/

Quality of life questionnaire (EORTC-QLQ-CR29 for colorectal cancer)

https://iciq.net/iciq-flutssex

ICIQ-FLUTSsex (questionnaire for sexual complaints in women)

Other Identifiers

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iRECOVER_2025

Identifier Type: -

Identifier Source: org_study_id

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