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Sacral neuromodulation for the prevention of a permanent stoma in patients with severe defecation disorder following intersphincteric resection

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Abstract

Purpose

Severe defecation disorder occurs frequently in coloanal anastomosis for low rectal cancer, and may affect quality of life. Sacral neuromodulation (SNM) has been reported to be successful after rectal resection, but there are no results for patients treated with intersphincteric resection (ISR).

Methods

A retrospective single-center study of SNM was performed for patient with defecation disorder following ISR. Pre- and post-treatment bowel frequencies, fecal incontinence episodes, and Wexner, LARS and FIQL scores were assessed to evaluate the efficacy. A good response was defined as ≥ 50% reduction of bowel frequency per day or fecal incontinence episodes per week.

Results

10 patients (7 males, mean age 67.5 years) underwent SNM. All patients had severe fecal incontinence with a median Wexner score of 15 (13–20) and a median LARS score of 41 (36–41). The Wexner score improved after SNM, but not significantly (p = 0.06). LARS and FIQL scores significantly improved after SNM (p = 0.02, p = 0.01). At the end of follow-up, the good response rate was 40%. Three cases without a good response required creation of a permanent stoma.

Conclusion

Seven out of 10 patients did not require a permanent colostomy after SNM. SNM should be considered before performing a permanent colostomy.

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Data availability

Raw data were generated at National Cancer Center Hospital East. Derived data supporting the findings of this study are available from the corresponding author [YN, MI] on request.

References

  1. Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M. Intersphincteric resection for low rectal tumours. Br J Surg. 1994;81:1376–8.

    Article  CAS  Google Scholar 

  2. Ito M, Saito N, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y. Analysis of clinical factors associated with anal function after intersphincteric resection for very low rectal cancer. Dis Colon Rectum. 2009;52:64–70.

    Article  Google Scholar 

  3. Saito N, Ito M, Kobayashi A, Nishizawa Y, Kojima M, Nishizawa Y, et al. Long-term outcomes after intersphincteric resection for low-lying rectal cancer. Ann Surg Oncol. 2014;21:3608–15.

    Article  Google Scholar 

  4. Kohler A, Athanasiadis S, Ommer A, Psarakis E. Long-term results of low anterior resection with intersphincteric anastomosis in carcinoma of the lower one-third of the rectum: analysis of 31 patients. Dis Colon Rectum. 2000;43:843–50.

    Article  CAS  Google Scholar 

  5. Tiret E, Poupardin B, McNamara D. Ultralow anterior resection with intersphincteric dissection; what is the limit of safe sphincter preservation? Colorectal Dis. 2003;5:454–7.

    Article  CAS  Google Scholar 

  6. Saito N, Ono M, Sugito M, Ito M, Morihiro M, Kosugi C, et al. Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomy. Dis Colon Rectum. 2004;47:459–66.

    Article  Google Scholar 

  7. Bretagnol F, Rullier E, Laurent C, Zerbib F, Gontier R, Saric J. Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer. Dis Colon Rectum. 2004;47:832–8.

    Article  Google Scholar 

  8. Ziv Y, Zbar A, Bar-Shavit Y, Igov I. Low anterior resection syndrome (LARS): cause and effect and reconstructive considerations. Tech Coloproctol. 2013;17:151–62.

    Article  CAS  Google Scholar 

  9. Camilleri-Brennan J, Steele RJ. Quality of life after treatment for rectal cancer. Br J Surg. 1998;85:1036–43.

    Article  CAS  Google Scholar 

  10. Bryant CL, Lunniss PJ, Knowles CH, Thaha MA, Chan CL. Anterior resection syndrome. Lancet Oncol. 2012;13:403–8.

    Article  Google Scholar 

  11. Keane C, Wells C, O’Grady G, Bissett IP. Defining low anterior resection syndrome: a systematic review of the literature. Colorectal Dis. 2017;19:713–22.

    Article  CAS  Google Scholar 

  12. Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2020;255:922–8.

    Article  Google Scholar 

  13. Dulskas A, Smolskas E, Kildusiene I, Samalavicius NE. Treatment possibilities for low anterior resection syndrome: a review of the literature. Int J Colorectal Dis. 2018;33:251–60.

    Article  Google Scholar 

  14. Dudding TC, Pares D, Vaizey CJ, Kamm MA. Predictive factors for successful sacral nerve stimulation in the treatment of faecal incontinence: a 10 year cohort analysis. Colorectal Dis. 2008;10:249–56.

    Article  CAS  Google Scholar 

  15. Boyle DJ, Murphy J, Gooneratne ML, Grimmer K, Allison ME, et al. Efficacy of sacral nerve stimulation for the treatment of fecal incontinence. Dis Colon Rectum. 2011;54:1271–8.

    Article  Google Scholar 

  16. Matzel KE, Stadelmaier U, Hohenfellner M, Gall FP. Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet. 1995;346:1124–7.

    Article  CAS  Google Scholar 

  17. Ramage L, Qiu S, Kontovounisios C, Tekkis P, Rasheed S, Tan E. A systematic review of sacral nerve stimulation for low anterior resection syndrome. Colorectal Dis. 2015;17:762–71.

    Article  CAS  Google Scholar 

  18. Thomas GP, Bradshaw E, Vaizey CJ. A review of sacral nerve stimulation for faecal incontinence following rectal surgery and radiotherapy. Colorectal Dis. 2015;17:939–42.

    Article  CAS  Google Scholar 

  19. Akizuki E, Matsuno H, Satoyoshi T. Validation of the Japanese version of the low anterior resection syndrome score. World J Surg. 2018;42:2660–7.

    Article  Google Scholar 

  20. Ogata H, Mimura T, Hanazaki K. Validation study of the Japanese version of the faecal incontinence quality of life scale. Colorectal Dis. 2012;14:194–9.

    Article  CAS  Google Scholar 

  21. Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, et al. Fecal incontinence quality of life scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum. 2000;43:9–16.

    Article  CAS  Google Scholar 

  22. Tan E, Ngo NT, Darzi A, Shenouda M, Tekkis PP. Meta-analysis: sacral nerve stimulation versus conservative therapy in the treatment of faecal incontinence. Int J Colorectal Dis. 2011;26:275–94.

    Article  Google Scholar 

  23. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  Google Scholar 

  24. Miles WE. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon. Lancet. 1908;2:1812–3.

    Article  Google Scholar 

  25. Saito N, Moriya Y, Shirouzu K, Maeda K, Mochizuki H, Koda K, et al. Intersphincteric resection in patients with very low rectal cancer: a review of the Japanese experience. Dis Colon Rectum. 2006;49:S13-22.

    Article  Google Scholar 

  26. Nishizawa Y, Fujii S, Saito N, Ito M, Ochiai A, Sugito M, et al. The association between anal function and neural degeneration after preoperative chemoradiotherapy followed by intersphincteric resection. Dis Colon Rectum. 2011;54:1423–9.

    Article  Google Scholar 

  27. Kitaguchi D, Nishizawa Y, Sasaki T, Tsukada Y, Ito M. Clinical benefit of high resolution anorectal manometry for the evaluation of anal function after intersphincteric resection. Colorectal Dis. 2019;21:335–41.

    Article  CAS  Google Scholar 

  28. Lin KY, Granger CL, Denehy L, Frawley HC. Pelvic floor muscle training for bowel dysfunction following colorectal cancer surgery: a systematic review 23, 2014. Neurourol Urodyn. 2015;34:703–12.

    Article  Google Scholar 

  29. Rosen H, Robert-Yap J, Tentschert G, Lechner M, Roche B. Transanal irrigation improves quality of life in patients with low anterior resection syndrome. Colorectal Dis. 2011;13:335–8.

    Article  Google Scholar 

  30. Matzel KE, Stadelmaier U, Bittorf B, Hohenfellner M, Hohenberger W. Bilateral sacral spinal nerve stimulation for fecal incontinence after low anterior rectum resection. Int J Colorectal Dis. 2002;17:430–4.

    Article  Google Scholar 

  31. Yokota M, Ito M, Nishizawa Y, Kobayashi A, Saito N. The impact of anastomotic leakage on anal function following intersphincteric resection. World J Surg. 2017;41:2168–77.

    Article  Google Scholar 

  32. Schwandner O. Sacral neuromodulation for faecal incontinence and “low anterior resection syndrome” following neoadjuvant therapy for rectal cancer. Int J Colorectal Dis. 2013;28:665–9.

    Article  CAS  Google Scholar 

  33. Koda K, Saito N, Seike K, Shimizu K, Kosugi C, Miyazaki M. Denervation of the neorectum as a potential cause of defecatory disorder following low anterior resection for rectal cancer. Dis Colon Rectum. 2005;48:210–7.

    Article  Google Scholar 

  34. Lee WY, Takahashi T, Pappas T, Mantyh CR, Ludwig KA. Surgical autonomic denervation results in altered colonic motility: an explanation for low anterior resection syndrome? Surgery. 2008;143:778–83.

    Article  Google Scholar 

  35. Tabe Y, Mochiki E, Ando H, et al. Correlation between colonic motility and defecatory disorders after anterior resection of the rectum in canine models. Neurogastroenterol Motil. 2008;20:1174–84.

    Article  CAS  Google Scholar 

  36. Chen TY, Emmertsen KJ, Laurberg S. Bowel dysfunction after rectal cancer treatment: a study comparing the specialist’s versus patient’s perspective. BMJ Open. 2014;4:e003374.

    Article  Google Scholar 

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Funding

Funding was from institutional sources only.

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Hiroya Enomoto, Yuji Nishizawa, Koji Inamori, Hiro Hasegawa, Koji Ikeda, Yuichiro Tsukada, Takeshi Sasaki & Masaaki Ito

Authors
  1. Hiroya Enomoto
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  2. Yuji Nishizawa
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  3. Koji Inamori
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  4. Hiro Hasegawa
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  5. Koji Ikeda
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  6. Yuichiro Tsukada
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  7. Takeshi Sasaki
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  8. Masaaki Ito
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Contributions

HE, KI, YN collected and interpreted data. HE and YN interpreted data, wrote the paper and contributed equally to the manuscript. KI, HH, KI, YT, TS, MI made substantial contributions to the conception and design of the study, and were all involved in drafting the manuscript and revising it critically for important intellectual content. All authors declare that they contributed to this article and that they all approve the final submitted version.

Corresponding authors

Correspondence to Yuji Nishizawa or Masaaki Ito.

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Enomoto, H., Nishizawa, Y., Inamori, K. et al. Sacral neuromodulation for the prevention of a permanent stoma in patients with severe defecation disorder following intersphincteric resection. Surg Today 51, 1379–1386 (2021). https://doi.org/10.1007/s00595-021-02233-5

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