Anal sphincter training benefits colorectal cancer surgery patients
MedWire News: French researchers have demonstrated the benefits of anal sphincter rehabilitation for patients who undergo extensive rectal surgery for cancer.
Their study, published in Colorectal Disease, suggests that anal sphincter physiotherapy can improve both markers of both functional outcome and quality of life (QoL) in all patients following total mesorectal excision (TME).
Yves Panis and co-workers, from Beaujon Hospital, Clichy, selected 22 patients undergoing laparoscopic TME for low colorectal cancer or colorectal anastomosis between 2007 and 2009 to receive postoperative anal sphincter rehabilitation. None of the patients had history of fecal incontinence.
The program consisted of 15 weekly 1-hour sessions of biofeedback and pelvic floor exercises with the intention of achieving a rectal capacity of 150 mL, perineal strength of 3/5, and perineal muscular locking. Patients were also asked to keep a symptom diary.
The patients given physiotherapy were compared with a further 24 laparoscopic colorectal surgery patients, matched by age, gender, tumor stage and height, and other pre- and postoperative factors, who did not receive the anal sphincter rehabilitation program.
All patients were assessed using one functional and two QoL questionnaires. The patients were followed up for a median of 21.2 months after stoma closure.
Analysis showed that continence, measured using both the Wexner score and Kirwan classification, was similar in the patients and controls.
However, patients who received physiotherapy had significantly lower mean stool frequency than controls (2.6 vs 4.0 per day), and were significantly less likely to experience dyschesia (22 vs 63%).
Furthermore, patients given physiotherapy had significantly greater vitality and mental functioning scores in the Short Form 36 (SF-36) Health Status questionnaire subscales. Anal sphincter training was also associated with significantly better scores for depression and self-perception on the Faecal Incontinence Quality of Life sore.
"It should be interesting to identify which patients are more likely to achieve success with anal sphincter rehabilitation," say Panis et al.
"Selecting those with a high risk of poor functional results postoperatively could help the surgeon to propose associated or postoperative procedures, such as simultaneous anal repair and sacral neuromodulation, until more radical surgery with APR and a definitive colostomy can be performed."
By Lynda Williams