Challenges in evaluating pelvic floor physiotherapy based strategies in low anterior resection syndrome: a systematic review and qualitative analysis

Pelvic floor muscle training for the prevention and management of low anterior resection syndrome in patients with rectal cancer: An evidence-based summary

Objective

This study aims to summarize the best available evidence on the effectiveness of pelvic floor muscle training (PFMT) in preventing and managing low anterior resection syndrome (LARS) among patients with rectal cancer, with the goal of enhancing quality of care.

Methods

A systematic search was conducted across databases, including BMJ Best Practice, UpToDate, WHO, GIN, UK NICE, NGC, SIGN, RNAO, NCCN, JBI Library, Cochrane Library, CINAHL, Web of Science, Embase, OVID, PubMed, Chinese Wanfang, CNKI, SinoMed, and VIP, covering publications from inception through June 30, 2024. We targeted clinical decisions, guidelines, evidence summaries, expert consensus statements, systematic reviews, and randomized controlled trials related to PFMT for LARS in patients with rectal cancer. Two independent reviewers assessed the quality of the literature and extracted key findings.

Results

A total of 15 articles were included, yielding 21 pieces of evidence across six core areas: multidisciplinary management, bowel function risk screening and assessment, the purpose and target population for PFMT, pre-exercise instructions, exercise regimens, and exercise feedback.

Conclusions

The summarized 21 recommendations provide guidance for integrating PFMT into care plans for patients with rectal cancer and LARS. However, given that evidence originates from diverse clinical settings, considerations such as the local health care environment should be evaluated before implementation. Future research should focus on optimizing PFMT regimens to improve bowel function outcomes in patients with rectal cancer, refining exercise protocols, and gathering further data to enhance clinical application.

Systematic review registration

Registered with the Fudan University Centre for Evidence-Based Nursing, registration number ES20245385.

The Role of Patient Education in Low Anterior Resection Syndrome: A Systematic Review

Low anterior resection syndrome (LARS) is a significant complication after sphincter-preserving rectal cancer surgery and negatively impacts a patient's quality of life. Treatment of LARS is multimodal, and many treatments require engagement from the patient. Understanding the complex array of treatment options and the potential additive effects of different therapies can be difficult. This systematic review aims to assess the role of patient education in treatment of LARS in colorectal cancer patients. A systematic literature search was conducted on PubMed, EMBASE and Ovid Medline according to the PRISMA guidelines for articles published from 1946 to October 2023 and registered with PROSPERO: 42,023,434,601. Studies that reported on clinical outcomes of patients with LARS that underwent any educational intervention were included for this review. Results from five publications including 368 patients with LARS were reviewed for analysis. Three interventions were delivered to symptomatic patients postoperatively and two to all patients who underwent low anterior resection preoperatively. Five trial protocols were also included for analysis, including three preoperative and two postoperative interventions Education interventions were often delivered alongside co-interventions such as medications and pelvic floor physiotherapy. Four studies reported improvement of mean LARS scores and quality of life measures related to the education intervention and associated co-interventions. Patient education has a positive impact towards improving functional outcomes in patients with LARS following resection for rectal cancer. In practice, it is often used in conjunction with other interventions. Determining optimal content and delivery methods is a target for future research.

Treatment of anterior resection syndrome: A systematic review and network meta-analysis

INTRODUCTION

There has been a lack of research comparing the efficacy of various treatments for low anterior resection syndrome (LARS).

METHODS

We conducted a comprehensive search across six electronic databases and a paired meta-analysis was undertaken to assess the effectiveness of the interventions. Furthermore, a network meta-analysis was utilized to compare the efficacy of different treatments for LARS.

RESULTS

This study encompassed nine randomized controlled trials, involving a total of 450 patients. Compared to routine care, 5-HT3 receptor antagonists (follow-up<3 months) and percutaneous tibial nerve stimulation (3 months ≤ follow-up <6 months) were effective in reducing the LARS score. Pelvic floor rehabilitation (follow-up≤3 months) was effective in decreasing daily number of bowel movements when compared to routine care. The network meta-analysis indicated that 5-HT3 receptor antagonists (follow-up<3 months) were the most effective in reducing both the LARS score and the daily number of bowel movements. Transanal irrigation (3 months ≤ follow-up ≤ 12 months) was most effective in reducing the LARS score. Additionally, 5-HT3 receptor antagonists demonstrated relative efficacy in improving patients' quality of life (follow-up ≤ 1 month).

CONCLUSIONS

This review indicates that 5-HT3 receptor antagonists and anal irrigation show significant promise in the treatment of LARS. Nevertheless, the contributions of percutaneous tibial nerve stimulation and pelvic floor rehabilitation to LARS treatment should not be overlooked. Given the clinical heterogeneity observed among the studies, the results should be interpreted with caution.