Chin J Bases Clin General Surg Vol 21 No 5 May DOI /
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1 Chin J Bases Clin General Surg Vol 21 No 5 May Wexner Wexner Wexner 9 R657 1 A Evaluation and Treatment for Fecal Incontinence after Sphincter-Preserving Operation for Middle and Low Rectal Cancer PI Yan-na 1 XIAO Yi 2 FANG Xiu-cai Department of Gastroenterology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China 2. Department of Surgery Peking Union Medical College Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing China Corresponding Author FANG Xiu-cai fangxiucai2@aliyun. com Abstract Objective To understand the incidence of fecal incontinence after sphincter-preserving operation for middle and low rectal cancer the factors influencing fecal incontinence the relationship of fecal incontinence to anorectal manometry and treatment. Method The literatures about fecal incontinence after sphincter-preserving operation for middle and low rectal cancer were reviewed. Results The incidence of fecal incontinence after sphincter-preserving operation for middle and low rectal cancer was about Wexner fecal incontinence score was the most popular scale in assessing the severity of fecal incontinence which had high validity and utility. When Wexner score 9 the fecal incontinence-related quality of life was seriously damaged. Closer the anastomosis to the anal margin the fecal incontinence was more likely to happen and much severer if it appeared. Surgeon could improve the anorectal function through some kinds of surgeries like ultralow anterior resection with levator-sphincter reinforcement when the tumor site was rather low. The effect of chemoradiotherapy on fecal incontinence was uncertain now. Age itself was a risk factor for fecal incontinence for elderly patients underwent sphincter-preserving operation needed to be careful. The relationship of fecal incontinence to anorectal function was not completely clear. The anal sphincter nerve function was a predicting factor whether neurogenic fecal incontinence was going to happen or not. Even though the retrograde colonic irrigation sacral nerve stimulation and biofeedback therapy had been proved to alleviate the symptoms and improve the quality DOI / AA BAI04B fangxiucai2@aliyun. com piyanna@126. com
2 Chin J Bases Clin General Surg Vol 21 No 5 May 2014 of life after sphincter-preserving operation much more prospective and controlled studies were needed to validate their efficacy and explore other new solutions. Conclusions We still need to come up with the objective criterion to assess fecal incontinence. Much more prospective studies are needed to analyze the influencing factors and to find effective prevention and treatment. Key words Rectal cancer Fecal incontinence Anorectal function Treatment Foundation item Project of The National High-Tech R & D Program 863 Program No. 2010AA National Key Technologies R & D Program in The 11th Five Year Plan Period No. 2007BAI04B cm 2 cm Wexner 8 Cleveland Wexner Vaizey AMS Pescatori Wexner Wexner Wexner Matzel 12 3 cm 4 6 cm 7 9 cm 10 cm Wexner 1 1 cm Wexner 1 2 cm 2 3 cm
3 Chin J Bases Clin General Surg Vol 21 No 5 May J / Kim NCCN 21 T 3 T 4 T Pucciarelli AMS d Wexner ? NCCN Gy Gy/ Gy 5 Gy/ P
4 Chin J Bases Clin General Surg Vol 21 No 5 May 2014 Lee 29 4 cm Koda Wexner 5 Wexner mm 15 1 mm 35 1 mm 24 9 mm P mm Hg 1 mm Hg kpa Wexner Kneist d Rosen Cleveland Wexner J (1) 1-12 Shibata D Guillem JG Lanouette N et al Functional and qualityof-life outcomes in patients with rectal cancer after combined
5 Chin J Bases Clin General Surg Vol 21 No 5 May modality therapy intraoperative radiation therapy and sphincter preservation J Dis Colon Rectum (6) Emmertsen KJ Laurberg S Bowel dysfunction after treatment for rectal cancer J Acta Oncol (6) Parés D Vial M Bohle B et al Prevalence of faecal incontinence and analysis of its impact on quality of life and mental health J Colorectal Dis (8) Bryant CL Lunniss PJ Knowles CH et al Anterior resection syndrome J Lancet Oncol (9) e403-e408 6 Rao SS American College of Gastroenterology Practice Parameters Committee Diagnosis and management of fecal incontinence J Am J Gastroenterol (8) Scheer AS Boushey RP Liang S et al The long-term gastrointestinal functional outcomes following curative anterior resection in adults with rectal cancer a systematic review and meta-analysis J Dis Colon Rectum (12) Vaizey CJ Carapeti E Cahill JA et al Prospective comparison of faecal incontinence grading systems J Gut (1) Bols EM Hendriks HJ Berghmans LC et al Responsiveness and interpretability of incontinence severity scores and FIQL in patients with fecal incontinence a secondary analysis from a randomized controlled trial J Int Urogynecol J (3) Rothbarth J Bemelman WA Meijerink W et al What is the impact of fecal incontinence on quality of life? J Dis Colon Rectum (1) Lynne B Nowak M Yik-Hong H Impact of fecal incontinence on quality of life J World J Gastroenterol (26) Matzel KE Stadelmaier U Muehldorfer S et al Continence after colorectal reconstruction following resection impact of level of anastomosis J Int J Colorectal Dis (2) J (2) Gross E Möslein G Colonic pouch and other procedures to improve the continence after low anterior rectal resection with TME J Zentralbl Chir (2) Zhang YC Jin XD Zhang YT et al Better functional outcome provided by short-armed sigmoid colon-rectal side-to-end anastomosis after laparoscopic low anterior resection a match-paired retrospective study from China J Int J Colorectal Dis (4) Bittorf B Stadelmaier U Göhl J et al Functional outcome after intersphincteric resection of the rectum with coloanal anastomosis in low rectal cancer J Eur J Surg Oncol (3) Tilney HS Tekkis PP Extending the horizons of restorative rectal surgery intersphincteric resection for low rectal cancer J Colorectal Dis (1) Bretagnol F Rullier E Laurent C et al Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer J Dis Colon Rectum (6) Vorobiev GI Odaryuk TS Tsarkov PV et al Resection of the rectum and total excision of the internal anal sphincter with smooth muscle plasty and colonic pouch for treatment of ultralow rectal carcinoma J Br J Surg (11) Kim JC Kim CW Yoon YS et al Levator-sphincter reinforcement after ultralow anterior resection in patients with low rectal cancer the surgical method and evaluation of anorectal physiology J Surg Today (6) Benson AB Bekaii-Saab T Chan E et al Rectal cancerclinical practice guidelines in oncology J J Natl Compr Canc Netw (12) Pucciarelli S Del Bianco P Efficace F et al Patient-reported outcomes after neoadjuvant chemoradiotherapy for rectal cancer a multicenter prospective observational study J Ann Surg (1) Canda AE Terzi C Gorken IB et al Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients J Int J Colorectal Dis (2) Lange MM den Dulk M Bossema ER et al Risk factors for faecal incontinence after rectal cancer treatment J Br J Surg (10) Swedish Rectal Cancer Trial Improved survival with preoperative radiotherapy in resectable rectal cancer J N Engl J Med (21) Peeters KC van de Velde CJ Leer JW et al Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer increased bowel dysfunction in irradiated patients a Dutch colorectal cancer group study J J Clin Oncol (25) Pollack J Holm T Cedermark B et al Long-term effect of preoperative radiation therapy on anorectal function J Dis Colon Rectum (3) J (10) Lee SJ Park YS Serial evaluation of anorectal function following low anterior resection of the rectum J Int J Colorectal Dis (5/6) J (4) Tomita R Igarashi S Fujisaki S Studies on anal canal sensitivity in patients with or without soiling after low anterior resection for lower rectal cancer J Hepatogastroenterology (85) Koda K Yasuda H Hirano A et al Evaluation of postoperative damage to anal sphincter/levator ani muscles with three-dimensional vector manometry after sphincter-preserving operation for rectal cancer J J Am Coll Surg (3) Kauff DW Kempski O Koch KP et al Continuous intraoperative monitoring of autonomic nerves during low anterior rectal resection an innovative approach for observation of functional nerve integrity in pelvic surgery J Langenbecks Arch Surg (5) Kneist W Kauff DW Gockel I et al Total mesorectal excision with intraoperative assessment of internal anal sphincter innervation provides new insights into neurogenic incontinence J J Am Coll Surg (3) Rosen H Robert-Yap J Tentschert G et al Transanal irrigation improves quality of life in patients with low anterior resection syndrome J Colorectal Dis (10) e335-e Koch SM Rietveld MP Govaert B et al Retrograde colonic irrigation for faecal incontinence after low anterior resection J Int J Colorectal Dis (9) Matzel KE Kamm MA Stösser M et al Sacral spinal nerve stimulation for faecal incontinence multicentre study J Lancet (9417) Tomita R Sacral nerve function in patients with soiling more than 10 years after low anterior resection for lower rectal cancer J Hepatogastroenterology (89) de Miguel M Oteiza F Ciga MA et al Sacral nerve stimulation for the treatment of faecal incontinence following low anterior resection for rectal cancer J Colorectal Dis (1) Kim KH Yu CS Yoon YS et al Effectiveness of biofeedback therapy in the treatment of anterior resection syndrome after rectal cancer surgery J Dis Colon Rectum (9) Bartlett L Sloots K Nowak M et al Biofeedback therapy for symptoms of bowel dysfunction following surgery for colorectal cancer J Tech Coloproctol (3)
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