title: Therapeutic Evaluation of Biofeedback Therapy in the Treatment of Anterior Resection Syndrome After Sphincter-Saving Surgery for Rectal Cancer.
abstract: Anterior resection syndrome (ARS) is common after sphincter-saving surgery for rectal cancer. It includes changes in the frequency and urgency of bowel movements and fecal incontinence. The therapeutic efficacy of biofeedback on ARS is unclear. We sought to evaluate the effectiveness of biofeedback therapy in patients with ARS after anterior resection for rectal cancer and to investigate the associated factors for therapeutic success.
  
  
  
  The study was designed as a retrospective review of the data from 61 patients with ARS collected from a prospectively maintained institutional cancer database. Therapeutic efficacy was evaluated using anorectal manometry, the number of bowel movements daily, and fecal incontinence scoring systems (Vaizey and/or Wexner scores). Changes of > 15% in the Vaizey and/or Wexner scores were considered to indicate effectiveness. Stepwise logistic regression models were performed to evaluate whether the associated factors influenced therapeutic efficacy.
  
  
  
  The parameters of anorectal manometry in patients with rectal cancer were significantly lower than those in control group (P < .01). After biofeedback therapy, significant improvements were observed in the incontinence scale scores (P < .001), number of bowel movements (P < .001), and anorectal manometry data (maximum resting pressure, P < .001; maximum squeeze pressure, P = .001; and rectal capacity, P = .015). In contrast, no significant difference in the rectal initial sensation threshold was observed (P = .089). Patients with fecal incontinence as the primary symptom experienced significant improvements in all variables (P < .01), except for the rectal initial sensation threshold (P = .125). Age at surgery, current smoking status, diabetes, treatment cycles, laparoscopic surgery, interval from surgery to biofeedback therapy, and the use of radiation therapy were closely associated with therapeutic success. On multivariate analysis, current smoking status (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.01-0.87), number of biofeedback therapy cycles (OR, 0.01; 95% CI, 0.00-0.06), and laparoscopic surgery (OR, 11.53; 95% CI, 1.17-113.61) were factors contributing to biofeedback therapeutic success.
  
  
  
  Biofeedback therapy can improve the anal function of patients after restorative resection for rectal cancer.
authors.affiliation: Department of Colorectal Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Zhonglin
authors.initials: Z
authors.lastname: Liang
authors.affiliation: Department of Colorectal Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Ding
authors.affiliation: Department of Colorectal Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Colorectal Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Zhongchuan
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Colorectal Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: dpdeney@163.com.
authors.forename: Peng
authors.initials: P
authors.lastname: Du
authors.affiliation: Department of Colorectal Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Long
authors.initials: L
authors.lastname: Cui
mesh_terms: D000328:Adult; D000368:Aged; D001676:Biofeedback, Psychology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012002:Rectal Diseases / Q000209:etiology* / Q000628:therapy*; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013577:Syndrome
keywords: Anterior resection syndrome; Biofeedback; Fecal incontinence; Rectal cancer