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International Journal of Colorectal Disease

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01-05-2013 | Original Article

Sacral neuromodulation for fecal incontinence and “low anterior resection syndrome” following neoadjuvant therapy for rectal cancer

Author: O. Schwandner

Published in: International Journal of Colorectal Disease | Issue 5/2013

Abstract

Background

It was the aim of this prospective study to analyze both feasibility and effectiveness of sacral neuromodulation for fecal incontinence and “low anterior resection syndrome” following neoadjuvant therapy for rectal cancer.

Methods

All patients who underwent sacral neuromdulation following neoadjuvant therapy for rectal cancer (preoperative radiochemotherapy, oncologic rectal resection with total mesorectal excision) were prospectively enrolled in the study. Only patients with failure of conservative treatment and without any evidence of residual or recurrent tumor disease were candidates for sacral neuromdulation which was performed by a two-stage procedure (diagnostic percutaneous test stimulation followed by definite implant). In addition to feasibility, primary end points included success (reduction of incontinent episodes), continence and defecation status (assessed by Cleveland Clinic Incontinence Score and Altomare score), and quality of life (EQ-5D). Anal manometry was performed preoperative and at 12-month follow-up. Follow-up information was derived from clinical examination 3, 6, and 12 months postoperatively.

Results

Nine patients (three females, six males) with a mean age of 61 years underwent sacral neuromodulation following neoadjuvant therapy for rectal cancer. Implantation rate was 100 %. No septic morbidity was observed. After a mean follow-up of 12 months, mean Cleveland Clinic Incontinence Score was reduced from 18.2 to 6.0 (p < 0.01). Incontinence episodes were significantly reduced from 7 to 0.5 (per day) and 20 to 8 (per week). Fecal urgency, fragmented defecation, and soiling were improved or resolved in two thirds. Altomare score was significantly reduced from 21.0 to 9.3 (p < 0.01). Anorectal manometry did not correlate with clinical success. Quality of life was significantly improved (EQ-5D generic: 0.42 vs. 0.74, EQ-5D-VAS score: 20 vs. 90, p < 0.01).

Conclusions

Preliminary results of sacral neuromodulation in patients with fecal incontinence and symptoms of “low anterior resection syndrome” are promising and enrich the therapeutic modalities if conservative management has failed.

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Title: Sacral neuromodulation for fecal incontinence and “low anterior resection syndrome” following neoadjuvant therapy for rectal cancer
Author: O. Schwandner
Publication date: 01-05-2013
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 5/2013
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-013-1687-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Sacral neuromodulation for fecal incontinence and “low anterior resection syndrome” following neoadjuvant therapy for rectal cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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