Serviço de Cirurgia Geral, Departamento de Cirurgia, Porto, CHUdSA, Portugal.
ICBAS-UP-School of Medicine and Biomedical Sciences, Porto, Portugal.
Int J Colorectal Dis. 2023 Jul 10;38(1):189. doi: 10.1007/s00384-023-04485-8.
It is estimated that approximately 70% of patients with rectal cancer who undergo surgery will suffer from Low Anterior Resection Syndrome (LARS). In the last decades, sacral neuromodulation (SNM) has been widely used in urinary dysfunction and in faecal incontinence refractory to medical treatment. Its application in LARS has been investigated and has shown promising results. The paper's aim is to present a systematic review and meta-analysis of the available literature and evaluate the therapeutic success of SNM in patients with LARS.
A systematic search was performed in international health-related databases: Cochrane Library, EMBASE, PubMed and SciELO. No restrictions on year of publication or language were applied. Retrieved articles were screened and selected according to set inclusion criteria. Data items were collected and processed for each included article and a meta-analysis was done according to the PRISMA guidelines. The primary outcome was the number of successful definitive SNM implants. Further outcomes included changes in bowel habits, incontinence scores, quality of life scores, anorectal manometry data and complications.
A total of 18 studies were included, with 164 patients being submitted to percutaneous nerve evaluation (PNE) with 91% responding successfully. During follow-up of therapeutic SNM some devices were explanted. The final clinical success rate was 77% after permanent implant. Other outcomes, such as the frequency of incontinent episodes, faecal incontinence scores, quality of life scores were overall improved after SNM. The meta-analysis showed a decrease in 10.11 incontinent episodes/week; a decrease of 9.86 points in the Wexner score and an increase in quality of life of 1.56 (pooled estimate). Changes in anorectal manometry were inconsistent. Local infection was the most common post-operative complication, followed by pain, mechanical issues, loss of efficacy and haematoma.
DISCUSSION/CONCLUSION: This is the largest systematic review and meta-analysis concerning the use of SNM in LARS patients. The findings support the available evidence that sacral neuromodulation can be effective in the treatment of LARS, with significant improvement in total incontinent episodes and patients´ quality of life.
据估计，大约 70%接受手术的直肠癌患者将患有低位前切除综合征（LARS）。在过去几十年中，骶神经调节（SNM）已广泛用于治疗尿功能障碍和药物难治性粪便失禁。其在 LARS 中的应用已得到研究，并显示出有希望的结果。本文旨在对现有文献进行系统回顾和荟萃分析，并评估 SNM 在 LARS 患者中的治疗成功率。
在国际健康相关数据库中进行了系统搜索：Cochrane 图书馆、EMBASE、PubMed 和 SciELO。未对出版年份或语言施加限制。根据设定的纳入标准筛选和选择检索到的文章。收集并处理每个纳入文章的数据项，并根据 PRISMA 指南进行荟萃分析。主要结局是成功的确定性 SNM 植入数量。进一步的结果包括排便习惯的改变、失禁评分、生活质量评分、肛肠测压数据和并发症。
共纳入 18 项研究，其中 164 例患者接受经皮神经评估（PNE），成功率为 91%。在治疗性 SNM 随访期间，一些设备被取出。永久性植入后最终临床成功率为 77%。其他结果，如失禁发作频率、粪便失禁评分、生活质量评分，在 SNM 后总体得到改善。荟萃分析显示每周失禁发作次数减少 10.11 次；Wexner 评分降低 9.86 分，生活质量提高 1.56 分（汇总估计值）。肛肠测压的变化不一致。术后最常见的并发症是局部感染，其次是疼痛、机械问题、疗效丧失和血肿。
讨论/结论：这是关于 SNM 在 LARS 患者中应用的最大系统评价和荟萃分析。研究结果支持现有证据表明，骶神经调节在治疗 LARS 方面可能有效，可显著改善总失禁发作次数和患者生活质量。
