{"id":8065,"date":"2026-04-03T10:59:54","date_gmt":"2026-04-03T10:59:54","guid":{"rendered":"https:\/\/www.proefschriftmaken.nl\/portfolio\/joost-van-der-heijden\/"},"modified":"2026-04-23T09:04:17","modified_gmt":"2026-04-23T09:04:17","slug":"joost-van-der-heijden","status":"publish","type":"us_portfolio","link":"https:\/\/www.proefschriftmaken.nl\/en\/portfolio\/joost-van-der-heijden\/","title":{"rendered":"Joost Van Der Heijden"},"content":{"rendered":"","protected":false},"excerpt":{"rendered":"","protected":false},"author":8,"featured_media":14146,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"us_portfolio_category":[45],"class_list":["post-8065","us_portfolio","type-us_portfolio","status-publish","has-post-thumbnail","hentry","us_portfolio_category-new-template"],"acf":{"naam_van_het_proefschift":"Anorectal function after sphincter-preserving rectal cancer surgery","samenvatting":"Er is geen Nederlandse samenvatting beschikbaar. De Engelse samenvatting vind je <a href=\"https:\/\/www.proefschriftmaken.nl\/en\/portfolio\/joost-van-der-heijden\/\">hier<\/a>.","summary":"English Summary\n\nThe aim of this thesis was to increase the awareness and to optimize the knowledge of the presence, impact, patients\u2019 perspective, screening and guidance of postoperative functional complaints after sphincter-preserving surgery for rectal cancer, and to prove a beneficial effect of pelvic floor rehabilitation on functional outcomes and quality of life after sphincter-preserving rectal cancer surgery.\n\nIn chapter 1, a general introduction into the history of the treatment of rectal cancer is provided. The developments that have led to the current sphincter-preserving surgical treatment are described. Subsequently, the \u2018low anterior resection syndrome\u2019 is introduced as a term that represents a disordered bowel dysfunction after rectal resection which leads to an impairment in quality of life. Associated symptoms are fecal incontinence, urgency, clustering, incontinence for flatus and a high bowel frequency.\n\nPART I The Low Anterior Resection Syndrome\n\nIn chapter 2, the results from three focus groups are described. Participants were patients who underwent sphincter-preserving surgical treatment for rectal cancer in the M\u00e1xima Medical Center. Their perspectives on illness perception, pre- and postoperative supportive care were evaluated. Patients with LARS reported a severe impact on their psychosocial functioning. The combination of clustering, urgency and a high frequency of stools was considered extremely bothering by the majority of patients. Even within the boundaries of a patients\u2019 own house, a reduced functioning was reported which sometimes was associated with depressive symptoms. Specific focus and screening for LARS appears to be necessary to break the taboo around some \u2018embarrassing\u2019 symptoms. Adequate preoperative counseling about possible postoperative functional problems turned out to be crucial for patients. Consensus was reached on a gap in supportive care directly after discharge from the hospital. In this period, patients did not know who to consult with their (bowel dysfunction related) problems.\n\nThese data were used to develop clinical recommendations to improve the follow-up care, which existed of the adequate use of screening tools to start an open discussion about potentially embarrassing symptoms in the outpatient clinics. Second, it was suggested to expand and improve the preoperative counselling on (potential) postoperative complaints. Third, a new telephonic consult was introduced three days after discharge in order to fill the \u2018gap of supportive care\u2019 that was reported. At last, general practitioners were informed about the possibility of LARS-like complaints in the discharge letter which should increase the awareness of LARS and should enable the GP\u2019s to refer patients back to the hospital for personalized guidance in case of severe complaints.\n\nAfter exploring the patients\u2019 perspective, a national survey among Dutch healthcare professionals was used to explore their perspective, knowledge and awareness of LARS. In chapter 3, the results of this survey are described. Respondents consisted of 142 colorectal surgeons and 101 colorectal and incontinence-care nurses from the Netherlands. The majority of healthcare professionals (81%) estimated the prevalence of major LARS below 60%, of which 37% thought that major LARS occurred in 20-40% of all patients. This serious underestimation (compared to the actual 60-70%) was significantly associated with years of work-experience. Furthermore, it was found that one in three health care professionals did not (systematically) assess the preoperative functional status which can be important for the actual surgery planning. After surgery, less than 50% of the surgeons used the LARS score or quality of life surveys to evaluate the presence and impact of functional complaints. Frequency of stools was the most frequent used parameter to objectify the postoperative functional status, while presence of fecal incontinence was reported as the most bothersome symptom by health care professionals.\n\nWith regard to the treatment of LARS, a significant variance in treatment methods and the way they were combined was reported. The majority of healthcare providers (90%) advised lifestyle adjustments, frequently accompanied by pharmacotherapy (61%). Others described pelvic floor rehabilitation, transanal irrigation and (sacral) neurostimulation as potential treatment options, without a uniform policy emerging from the results. The demand for an evidence-based guideline was expressed.\n\nIn chapter 4, the development and implementation of a postoperative patient-driven guidance protocol for functional complaints after sphincter-preserving surgery for rectal cancer is described. The clinical recommendations from chapter 2 and 3 were incorporated in this protocol. We hypothesized that this protocol could lead to a better self-management and improved coping of the patient. To evaluate the impact of this new protocol, a retrospective comparative cohort study was performed. The LARS scores and quality of life of patients after low anterior resection (LAR) and sigmoid resection were collected from patients who were guided before (n=195) and after (n=48) implementation. Patients who underwent LAR and were guided after the implementation showed significantly lower median LARS scores (18 vs. 31, p=0.02) and lower percentages of major LARS (26.3 vs. 51.9%, p=0.045). No differences were found after sigmoid resection. Multiple differences in quality of life domains were found in favour of those patients who underwent LAR and were guided after the implementation of the protocol. Although diverse patient characteristics did not covenant between groups, caregivers were advised to re-evaluate their current postoperative guidance program and to implement elements of this non-invasive, patient-driven protocol. We suggest that this will improve patients\u2019 coping mechanisms, self-management and subsequent quality of life.","auteur":"Joost Van Der Heijden","auteur_slug":"joost-van-der-heijden","publicatiedatum":"15 februari 2022","taal":"NL","url_flipbook":"https:\/\/ebook.proefschriftmaken.nl\/ebook\/joostvanderheijden?iframe=true","url_download_pdf":"","url_epub":"","ordernummer":"FTP-202604031055","isbn":"978-94-6423-525-8","doi_nummer":"","naam_universiteit":"Radboud Universiteit","afbeeldingen":14146,"naam_student:":"","binnenwerk":"","universiteit":"Radboud Universiteit","cover":"","afwerking":"","cover_afwerking":"","design":""},"_links":{"self":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/8065","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio"}],"about":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/types\/us_portfolio"}],"author":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/comments?post=8065"}],"version-history":[{"count":1,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/8065\/revisions"}],"predecessor-version":[{"id":8066,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/8065\/revisions\/8066"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/media\/14146"}],"wp:attachment":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/media?parent=8065"}],"wp:term":[{"taxonomy":"us_portfolio_category","embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio_category?post=8065"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}