title: Functional disorders after rectal cancer resection: does a rehabilitation programme improve anal continence and quality of life?
abstract: OBJECTIVE
  A poor functional outcome is often reported after total mesorectal excision (TME) for rectal cancer, especially when sphincter-saving resection with intersphincteric dissection is performed for low tumours. Anal sphincter rehabilitation is widely proposed for faecal incontinence. Very few studies have reported results to improve anal dysfunction following rectal surgery. This prospective study aimed to assess the benefits of sphincter training after TME in terms of functional outcome and quality of life.
  
  
  METHODS
  Anal sphincter training was performed in patients undergoing laparoscopic sphincter-saving TME for rectal cancer. Rehabilitation was performed after ileostomy closure. This group was compared with 24 matched patients. Assessment included one functional and two quality of life questionnaires (SF-36 Health Status and Faecal Incontinence Quality of Life score).
  
  
  RESULTS
  From 2007 to 2009, 22 patients underwent laparoscopic TME. The median follow-up after stoma closure was 21.2 (range 8-46) months. The mean stool frequency per day was significantly lower after sphincter training (2.6 in the training group vs 4.0 in the control group, P=0.025). Following rehabilitation, patients complained significantly less about dyschezia (22 vs 63%, P=0.008). Both groups had similar continence (Wexner score 8.3 after training vs 9.9 in controls, NS). Quality of life was significantly improved by sphincter training as measured by the vitality (P=0.004) and mental functioning (P=0.02) subscales on the SF-36 Health Status questionnaire and by the depression and self-perception (P = 0.005) categories of the Faecal Incontinence Quality of Life score.
  
  
  CONCLUSIONS
  This study suggests that anal sphincter training following TME could decrease stool frequency and improve both general and specific quality of life.
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, University Paris VII, Clichy, France.
authors.forename: A
authors.initials: A
authors.lastname: Laforest
authors.forename: F
authors.initials: F
authors.lastname: Bretagnol
authors.forename: A S
authors.initials: AS
authors.lastname: Mouazan
authors.forename: L
authors.initials: L
authors.lastname: Maggiori
authors.forename: M
authors.initials: M
authors.lastname: Ferron
authors.forename: Y
authors.initials: Y
authors.lastname: Panis
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000502:physiology; D000714:Anastomosis, Surgical; D001676:Biofeedback, Psychology; D003106:Colon / Q000601:surgery; D005081:Exercise Therapy; D005242:Fecal Incontinence / Q000209:etiology / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000534:rehabilitation*; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome