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Efficacy of pelvic floor rehabilitation for bowel dysfunction after anterior resection for colorectal cancer: a systematic review

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Abstract

Purpose

Bowel dysfunction is common after anterior resection for colorectal cancer (CRC). Pelvic floor rehabilitation (PFR) may improve functional outcomes after surgery. This review aimed to evaluate the efficacy of PFR for patients with bowel symptoms after anterior resection.

Methods

MEDLINE, CINHAL, PUBMED, EMBASE, Scopus, PsycINFO, Web of Science, PEDRO and Cochrane Library were searched from inception to June 2019. A final search was performed on 11 July 2020. Randomised controlled trials (RCTs), cohort studies, case-control studies and case series of bowel dysfunction after CRC surgery and PFR were eligible for review. Outcome measures were bowel function changes measured by patient-reported outcomes and manometric measurement. Risk of bias assessments using Methodological Index for Non-Randomized Studies (MINORS) tool and Newcastle Ottawa Scale (NOS) were conducted.

Results

Eleven trials met eligibility criteria: four retrospective studies and seven prospective, non-randomised controlled studies. A total of 516 participants were included, of which 455 received PFR. Functional outcomes were measured by bowel functional outcome questionnaires, patient diary, anorectal manometry and three studies measured quality of life. Faecal incontinence was improved in seven studies, and bowel frequency also decreased in five studies. The mean MINORS score was 10 (8–13) out of 16 in non-comparative groups and 18 (16–22) out of 24 in comparative groups; the NOS was 4.2 (3–7) out of 9. The overall risk of bias was high in most studies.

Conclusions

PFR appears to be beneficial for improving bowel function after anterior resection for CRC. However, the studies included had methodological limitations, so further investigation on the effectiveness of PFR is warranted.

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References

  1. International Agency for Research on Cancer (2018) Global Cancer Observatory: colorectum and anus

  2. International Agency for Research on Cancer (2018) 5-year survival

  3. Garcia-Aguilar J, Glynne-Jones R, Schrag D (2016) Multimodal rectal cancer treatment: in some cases. Less May Be More American Society of Clinical Oncology Educational Book 36:92–102

    Article  Google Scholar 

  4. Lirici MM, Hüscher CGS (2016) Techniques and technology evolution of rectal cancer surgery: a history of more than a hundred years. Minim Invasive Ther Allied Technol 25(5):226–233

    Article  Google Scholar 

  5. Downing A, Glaser AW, Finan PJ, Wright P, Thomas JD, Gilbert A, Corner J, Richards M, Morris EJA, Sebag-Montefiore D (2019) Functional outcomes and health-related quality of life after curative treatment for rectal cancer: a population-level study in England. International Journal of Radiation Oncology Biology Physics 103(5):1132–1142

    Article  Google Scholar 

  6. Näsvall P, Dahlstrand U, Löwenmark T, Rutegård J, Gunnarsson U, Strigård K (2017) Quality of life in patients with a permanent stoma after rectal cancer surgery. Qual Life Res 26(1):55–64

    Article  Google Scholar 

  7. Juul T et al (2014) International validation of the low anterior resection syndrome score. Ann Surg 259(4):728–734

    Article  Google Scholar 

  8. Croese A, Lonie JM, Trollope AF, Vangaveti VN, Ho YH (2018) A meta-analysis of the prevalence of low anterior resection syndrome and systematic review of risk factors. Int J Surg 56:234–241

    Article  Google Scholar 

  9. Celia Keane NSF, Bordeianou LG, Christensen P, Basany EE, Laurberg S, Mellgren A, Messick C, Orangio GR, Verjee A, Wing K, Bissett IP (2020) International consensus definition of low anterior resection syndrome. ANZ Journal of Surgery 90(3):300–307

  10. Bryant C et al (2012) Anterior resection syndrome. Lancet Oncol 13:e403–e408

    Article  Google Scholar 

  11. Sturiale A, Martellucci J, Zurli L, Vaccaro C, Brusciano L, Limongelli P, Docimo L, Valeri A (2017) Long-term functional follow-up after anterior rectal resection for cancer. Int J Color Dis 32:83–88

    Article  Google Scholar 

  12. Reinwalds M, Blixter A, Carlsson E (2018) Living with a resected rectum after rectal cancer surgery struggling not to let bowel function control life. J Clin Nurs 27(3–4):e623–e634

    PubMed  Google Scholar 

  13. Wells C et al (2015) Anterior resection syndrome—a risk factor analysis. J Gastrointest Surg 19(2):350–359

    Article  Google Scholar 

  14. Dulskas A, Smolskas E, Kildusiene I, Samalavicius NE (2018) Treatment possibilities for low anterior resection syndrome: a review of the literature. Int J Color Dis 33(3):251–260

    Article  Google Scholar 

  15. Bazzell A, Madsen LT, Dains J (2016) Clinical management of bowel dysfunction after low anterior resection for rectal cancer. Journal of the advanced practitioner in oncology 7(6):618–629

    PubMed  PubMed Central  Google Scholar 

  16. Ridolfi T, Berger N, Ludwig K (2016) Low anterior resection syndrome: current management and future directions. Clin Colon Rectal Surg 29(3):239–245

    Article  Google Scholar 

  17. Maris A et al (2012) Treatment options to improvec anorectal function following retal resection: a systematic review. Color Dis 15:e67–e78

    Article  Google Scholar 

  18. Lundby L, Duelund-Jakobsen J (2011) Management of fecal incontinence after treatment for rectal cancer. Curr Opin Support Palliat Care 5(1):60–64

    Article  Google Scholar 

  19. Martellucci J (2016) Low anterior resection syndrome: a treatment algorithm. Dis Colon Rectum 59(1):79–82

    Article  Google Scholar 

  20. Visser WS, te Riele WW, Boerma D, van Ramshorst B, van Westreenen HL (2014) Pelvic floor rehabilitation to improve functional outcome after a low anterior resection: a systematic review. Annals of Coloproctology 30(3):109–114

    Article  Google Scholar 

  21. Lin KY, Granger CL, Denehy L, Frawley HC (2015) Pelvic floor muscle training for bowel dysfunction following colorectal cancer surgery: a systematic review. Neurourol Urodyn 34(8):703–712

    Article  Google Scholar 

  22. Liberati A, Altman Douglas G, TetzlaffJennifer, Mulrow Cynthia, Gøtzsche Peter C, Ioannidis John P A et al (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. Bmj;339:b2700

  23. Scott K (2014) Pelvic floor rehabilitation in the treatment of fecal incontinence. Clin Colon Rectal Surg 27:99–105

    Article  Google Scholar 

  24. Slim K (2003) N.E., Forestier D, Kwiatkowski F, Panis Y, Chipponi J Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73:712–716

    Article  Google Scholar 

  25. Glasziou P, Irwig L, Bain C, Colditz G (2000) How to use the evidence: assessment and applicaiton of scientific evidence. NHMRC, Canberra

  26. McHugh ML (2012) Interrater reliability: the kappa statistic. Biochemia medica 22(3):276–282

    Article  Google Scholar 

  27. Bartlett L, Sloots K, Nowak M, Ho YH (2011) Biofeedback therapy for symptoms of bowel dysfunction following surgery for colorectal cancer. Techniques in Coloproctology 15(3):319–326

    Article  CAS  Google Scholar 

  28. Ho YY-H et al (1996) Biofeedback therapy for excessive stool frequency and incontinence following anterior resection or total colectomy. Dis Colon Rectum 39(11):1289–1292

    Article  CAS  Google Scholar 

  29. Ho YH, Tan M (1997) Biofeedback therapy for bowel dysfunction following low anterior resection. Ann Acad Med Singap 26(3):299–302

    CAS  PubMed  Google Scholar 

  30. Laforest A, Bretagnol F, Mouazan AS, Maggiori L, Ferron M, Panis Y (2012) Functional disorders after rectal cancer resection: does a rehabilitation programme improve anal continence and quality of life? Color Dis 14(10):1231–1237

    Article  CAS  Google Scholar 

  31. Lin YH, Yang HY, Hung SL, Chen HP, Liu KW, Chen TB, Chi SC (2016) Effects of pelvic floor muscle exercise on faecal incontinence in rectal cancer patients after stoma closure. European journal of cancer care 25(3):449–457

    Article  Google Scholar 

  32. Liu CH, Chen CH, Lee JC (2011) Rehabilitation exercise on the quality of life in anal sphincter-preserving surgery. Hepatogastroenterology 58(110–111):1461–1465

    PubMed  Google Scholar 

  33. Allgayer H et al (2005) Prospective comparison of short- and long-term effects of pelvic floor exercise/biofeedback training in patients with fecal incontinence after surgery plus irradiation versus surgery alone for colorectal cancer: clinical, functional and endoscopic/endosonographic findings. Scand J Gastroenterol 40(10):1168–1175

    Article  Google Scholar 

  34. Kim KH, Yu CS, Yoon YS, Yoon SN, Lim SB, Kim JC (2011) Effectiveness of biofeedback therapy in the treatment of anterior resection syndrome after rectal cancer surgery. Dis Colon Rectum 54(9):1107–1113

    Article  Google Scholar 

  35. Kuo LJ, Lin YC, Lai CH, Lin YK, Huang YS, Hu CC, Chen SC (2015) Improvement of fecal incontinence and quality of life by electrical stimulation and biofeedback for patients with low rectal cancer after intersphincteric resection. Arch Phys Med Rehabil 96(8):1442–1447

    Article  Google Scholar 

  36. Liang Z, Ding W, Chen W, Wang Z, du P, Cui L (2016) Therapeutic evaluation of biofeedback therapy in the treatment of anterior resection syndrome after sphincter-saving surgery for rectal cancer. Clin Colorectal Cancer 15(3):e101–e107

    Article  Google Scholar 

  37. Nishigori H, Ishii M, Kokado Y, Fujimoto K, Higashiyama H (2018) Effectiveness of pelvic floor rehabilitation for bowel dysfunction after intersphincteric resection for lower rectal Cancer. World J Surg 42(10):3415–3421

    Article  Google Scholar 

  38. Pucciani F, Ringressi MN, Redditi S, Masi A, Giani I (2008) Rehabilitation of fecal incontinence after sphincter-saving surgery for rectal cancer: encouraging results. Dis Colon Rectum 51(10):1552–1558

    Article  Google Scholar 

  39. Yin L et al (2018) Bowel symptoms and self-care strategies of survivors in the process of restoration after low anterior resection of rectal cancer (Report). BMC Surg 18(1)

  40. Pedersen EK et al (1986) Anorectal function after low anterior resection for carcinoma. Ann Surg 204(2):133–135

    Article  CAS  Google Scholar 

  41. Norton C, Cody J (2012) Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults (Cochrane review) [with consumer summary]. Cochrane Database of Systematic Reviews (7):1465–1858

  42. Rao SCS et al (2010) Long-term efficacy of biofeedback therapy for dyssynergic defecation: randomized controlled trial. Am J Gastroenterol 105(4):890–896

    Article  Google Scholar 

  43. Hoffmann TC et al (2017) Enhancing the usability of systematic reviews by improving the consideration and description of interventions. Bmj 358

  44. Emmertsen K, Laureberg S (2012) Low anterior resection syndrome score: development andd validation of a symptom-based scoring system for bowel dysfucntion after low anterior resection for rectal cancer. Annals of surgery 255(5):922–928

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Concord Cancer Centre, Concord Repatriation & General Hospital, Hospital Road, Sydney, NSW, 2139, Australia

    K. Y. C. Chan & Janette L. Vardy

  2. Faculty of Medicine and Health, University of Sydney, Sydney, Australia

    K. Y. C. Chan, M. Suen, S. Coulson & Janette L. Vardy

  3. Department of Colorectal Surgery, Concord Repatriation & General Hospital, Concord, NSW, 2139, Australia

    M. Suen

Authors
  1. K. Y. C. Chan
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  2. M. Suen
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  3. S. Coulson
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  4. Janette L. Vardy
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Contributions

JV is the guarantor. KYC drafted the manuscript. KYC, MS and JV contributed to the development of the selection, the risk of bias assessment strategy and data extraction criteria. KYC developed the search strategy. MS provided expertise on anterior resection. SC and all authors read, provided feedback and approved the final manuscript.

Corresponding author

Correspondence to Janette L. Vardy.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This review article does not have human participation trials conducted by any of the authors.

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Not applicable.

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Appendix. An example of search strategy

Appendix. An example of search strategy

Database: Ovid MEDLINE(R) ALL <1946 to June 26, 2019>

Search Strategy:

  1. 1

    Colorectal cancer.mp. or Colorectal Neoplasms/ (116527)

  2. 2

    rectal cancer.mp. or Rectal Neoplasms/ (46607)

  3. 3

    anterior resection.mp. (4289)

  4. 4

    bowel function.mp. (3320)

  5. 5

    Fecal Incontinence/ or faecal incontinence.mp. (10106)

  6. 6

    anterior resection syndrome.mp. (158)

  7. 7

    pelvic floor.mp. or Pelvic Floor/ (10236)

  8. 8

    training.mp. (404940)

  9. 9

    rehabilitation.mp. or Rehabilitation/ (301618)

  10. 10

    biofeedback.mp. or Biofeedback, Psychology/ (9837)

  11. 11

    Exercise/ or exercise.mp. (327634)

  12. 12

    1 or 2 or 3 (155700)

  13. 13

    4 or 5 or 6 (13166)

  14. 14

    7 or 8 or 9 or 10 or 11 (935614)

  15. 15

    12 and 13 and 14 (111)

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Chan, K.Y.C., Suen, M., Coulson, S. et al. Efficacy of pelvic floor rehabilitation for bowel dysfunction after anterior resection for colorectal cancer: a systematic review. Support Care Cancer 29, 1795–1809 (2021). https://doi.org/10.1007/s00520-020-05832-z

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  • DOI: https://doi.org/10.1007/s00520-020-05832-z

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