Colorectal and Pelvic Floor Diseases Center, Department of General Surgery, "S. Maria dei Battuti" Hospital, Via Brigata Bisagno, 4, 31015, Conegliano, TV, Italy.
Colorectal and Pelvic Floor Unit, Department of General Surgery, Treviso Regional Hospital, Treviso, Italy.
Tech Coloproctol. 2018 Feb;22(2):97-105. doi: 10.1007/s10151-017-1745-2. Epub 2018 Jan 8.
To assess whether sacral nerve stimulation (SNS) is an effective treatment for severe fecal incontinence (FI) after radiotherapy (RT)/chemoRT (CRT) in combination with pelvic surgery.
A multicenter study was conducted on patients with FI that developed after multimodal therapy for pelvic tumors and was refractory to non-operative management, who were treated with SNS between November 2009 and November 2012. Data were prospectively collected and retrospectively analyzed. Cleveland Clinic FI score (CCFIS), FI episodes per week, FI Quality of Life (FIQoL), anorectal manometry and pudendal nerve terminal motor latency were evaluated before and after SNS.
Eleven patients (seven females, mean age 67.3 ± 4.8 years) were evaluated in the study period. Multimodal treatments included surgery and CRT (four rectal, two cervical and one prostate cancers), surgery and RT (one cervical and two endometrial cancers) and CRT (one anal cancer). The mean radiation dose was 5.3 Gy, and mean interval between the end of RT and onset of FI was 43.7 ± 23 months. Before SNS, the mean CCFIS and the mean number of FI episodes per week were 15.7 ± 2.8 and 12.3 ± 4.2, respectively. At 12-month follow-up, mean CCFIS improved to 3.6 ± 1.8 (p = 0.003) and the mean number of FI episodes decreased to 2.0 ± 1.9 per week (p = 0.003). These results persisted at 24-month follow-up. Significant improvement was also observed for each of the four domains of FIQoL at 12- and 24-month follow-up. Anorectal manometry values did not change significantly at follow-up.
SNS is feasible and may be an effective therapeutic option for FI after multimodal treatment of pelvic malignancies.
评估骶神经刺激（SNS）是否对盆腔肿瘤多模式治疗后并发且对非手术治疗抵抗的严重粪便失禁（FI）患者有效。
对 2009 年 11 月至 2012 年 11 月间因盆腔肿瘤多模式治疗后发生且对非手术治疗抵抗的 FI 患者采用 SNS 治疗的病例进行多中心研究。前瞻性收集数据并进行回顾性分析。在 SNS 治疗前后分别评估克利夫兰诊所 FI 评分（CCFIS）、每周 FI 发作次数、FI 生活质量（FIQoL）、肛门直肠测压和阴部神经末端运动潜伏期。
研究期间共纳入 11 例患者（7 例女性，平均年龄 67.3±4.8 岁）。多模式治疗包括手术和放化疗（4 例直肠癌、2 例宫颈癌和 1 例前列腺癌）、手术和放疗（1 例宫颈癌和 2 例子宫内膜癌）和放化疗（1 例肛门癌）。平均放疗剂量为 5.3Gy，放疗结束至 FI 发作的平均时间间隔为 43.7±23 个月。SNS 治疗前，CCFIS 平均为 15.7±2.8，每周 FI 发作次数平均为 12.3±4.2。12 个月随访时，CCFIS 平均改善至 3.6±1.8（p=0.003），每周 FI 发作次数减少至 2.0±1.9 次（p=0.003）。24 个月随访时，这些结果仍持续存在。12-24 个月随访时，FIQoL 的四个领域也均有显著改善。肛门直肠测压值在随访时无显著变化。
SNS 是可行的，对于盆腔恶性肿瘤多模式治疗后发生的 FI 可能是一种有效的治疗选择。
