Advances in functional assessment and bowel rehabilitation following intersphincteric resection for low rectal cancer.
10.3760/cma.j.cn441530-20230310-00076
- VernacularTitle:低位直肠癌经括约肌间切除术后肛门功能评估体系与康复研究进展
- Author:
Bin ZHANG
1
;
Jian Hua DING
1
Author Information
1. Department of Colorectal Surgery, the Characteristic Medical Center of PLA Rocket Force, Beijing 100088, China.
- Publication Type:Journal Article
- MeSH:
Humans;
Rectal Neoplasms/surgery*;
Postoperative Complications;
Anal Canal/surgery*;
Quality of Life;
Organ Sparing Treatments;
Fecal Incontinence
- From:
Chinese Journal of Gastrointestinal Surgery
2023;26(6):607-613
- CountryChina
- Language:Chinese
-
Abstract:
Intersphincteric resection (ISR) has been performed as an ultimate sphincter-sparing strategy in selected patients with low rectal cancer. Accumulating evidence suggests that ISR may be an interesting alternative to abdominoperineal resection to avoid a permanent stoma without compromising oncological outcomes. However, bowel dysfunction is a most common consequence of ISR not to be neglected. To date, limited clinical research has reported functional and quality of life outcomes according to patient-reported outcome measures. Also, data concerning management of low anterior resection syndrome are scarce due to lack of quality evidence. Therefore, this review provides an up-to-date summary of systematic assessment (including function, quality of life, manometry and morphology) and bowel rehabilitation for ISR patients. Postoperative anal function is often assessed by a combination of scales, including the Incontinence Assessment Scale, the Gastrointestinal Function Questionnaire, the Specific LARS Assessment Scale and the Faecal Diary. The condition-specific Quality of Life Scale is more appropriate for Quality-of-life measures in fecal incontinence after ISR. Patients' physiological function after ISR can be assessed using water- or high-resolution solid-state anorectal manometry. Anatomical and morphological changes can be assessed using defecography and 3D endorectal ultrasound. Electrical stimulation and biofeedback, pelvic floor exercises, rectal balloon training, transanal irrigation and sacral neuromodulation are all options for post-operative rehabilitation.
