Abstract
Background
Anterior resection syndrome (ARS) is common after sphincter-saving surgery for rectal
cancer. It includes changes in the frequency and urgency of bowel movements and fecal
incontinence. The therapeutic efficacy of biofeedback on ARS is unclear. We sought
to evaluate the effectiveness of biofeedback therapy in patients with ARS after anterior
resection for rectal cancer and to investigate the associated factors for therapeutic
success.
Patients and Methods
The study was designed as a retrospective review of the data from 61 patients with
ARS collected from a prospectively maintained institutional cancer database. Therapeutic
efficacy was evaluated using anorectal manometry, the number of bowel movements daily,
and fecal incontinence scoring systems (Vaizey and/or Wexner scores). Changes of >
15% in the Vaizey and/or Wexner scores were considered to indicate effectiveness.
Stepwise logistic regression models were performed to evaluate whether the associated
factors influenced therapeutic efficacy.
Results
The parameters of anorectal manometry in patients with rectal cancer were significantly
lower than those in control group (P < .01). After biofeedback therapy, significant improvements were observed in the
incontinence scale scores (P < .001), number of bowel movements (P < .001), and anorectal manometry data (maximum resting pressure, P < .001; maximum squeeze pressure, P = .001; and rectal capacity, P = .015). In contrast, no significant difference in the rectal initial sensation threshold
was observed (P = .089). Patients with fecal incontinence as the primary symptom experienced significant
improvements in all variables (P < .01), except for the rectal initial sensation threshold (P = .125). Age at surgery, current smoking status, diabetes, treatment cycles, laparoscopic
surgery, interval from surgery to biofeedback therapy, and the use of radiation therapy
were closely associated with therapeutic success. On multivariate analysis, current
smoking status (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.01-0.87), number
of biofeedback therapy cycles (OR, 0.01; 95% CI, 0.00-0.06), and laparoscopic surgery
(OR, 11.53; 95% CI, 1.17-113.61) were factors contributing to biofeedback therapeutic
success.
Conclusion
Biofeedback therapy can improve the anal function of patients after restorative resection
for rectal cancer.
Keywords
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Article info
Publication history
Published online: November 27, 2015
Accepted:
November 23,
2015
Received in revised form:
November 2,
2015
Received:
August 18,
2015
Identification
Copyright
© 2015 Elsevier Inc. All rights reserved.
