Abstract
Purpose: To evaluate the effectiveness of the comprehensive post-operative management including low-frequency endo-anal electrical stimulation and daily suppository usage on post-operative anal functional recovery for low rectal cancer patients who underwent robotic total intersphincteric resection (ISR).Methods: A retrospective analysis was performed on 42 low rectal cancer patients who underwent robotic total ISR, of which 23 patients received comprehensive post-operative management, including biofeedback low-frequency endo-anal electrical stimulation and daily suppository usage (management group). Wexner score and anorectal manometric values, including resting pressure (RP), maximum squeeze pressure (MSP), initial perceived volume (IPV), and maximum tolerated volume (MTV), were assessed and compared.Results: A total of 42 low rectal cancer patients were included in our study. The RP at 6 months after ISR (40.95 ± 6.95 mmHg vs. 33.29 ± 5.40 mmHg, p = 0.002) and MSP at 3 and 6 months after ISR (72.05 ± 10.16 mmHg vs. 69.05 ± 8.67 mmHg, p = 0.031; 91.57 ± 15.47 mmHg vs. 84.05 ± 12.94 mmHg, p = 0.039, respectively) were significantly higher in the management group. The median IPV at 1 and 3 months after ISR (17.81 ± 3.61 ml vs. 15.43 ± 5.08 ml, p = 0.038; 20.19 ± 4.35 ml vs. 17.67 ± 5.16 ml, p = 0.044, respectively) and MTV at 3 months after ISR (83.71 ± 5.44 ml vs. 76.10 ± 8.42 ml, p = 0.012) were significantly higher in the management group. Wexner scores at 1 and 3 months after closure of stoma (COS) in the management group were significantly lower (11.3 ± 2.9 vs. 13.4 ± 3.0, p = 0.041; 8.9 ± 2.0 vs. 10.6 ± 2.4, p = 0.036, respectively).Conclusions: Comprehensive post-operative management could accelerate the recovery of sphincteric function and anal sensitivity after robotic total ISR and could also contribute to treatment of fecal incontinence followed by COS.
Highlights
Abdominoperineal resection (APR) is a standard procedure for the curative resection of low rectal cancer
A total of 42 low rectal cancer patients who received robotic total intersphincteric resection (ISR) were included in this study
All patients received stoma closure 3–6 months after ISR, and none of these patients received the conversion to permanent colostomy for the intolerability of fecal incontinence
Summary
Abdominoperineal resection (APR) is a standard procedure for the curative resection of low rectal cancer. The anal functional outcome has been indicated to be acceptable, especially for partial and subtotal ISR. Total ISR is performed for extremely low rectal cancer, and the incidence rate of anal dysfunction, resulting in a conversion to colostomy and reduced quality of daily life, is relatively higher with total ISR than with subtotal or partial ISR [5]. Electrical stimulation, especially low-frequency electrical biofeedback treatment, has been proven useful and is regarded as the first-line treatment for patients with fecal incontinence. Given that the fecal incontinence after robotic ISR is mainly attributed to resection of the internal sphincter muscle, we proposed comprehensive post-operative management, including biofeedback low-frequency endo-anal electrical stimulation and daily suppository usage, for patients who received robotic total ISR to evaluate the anal functional recovery efficacy
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