Liu Tingting, Jiao Xueping, Hu Congli, Su Rui, Dong Jiangfeng, Niu Qiaohong
Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi Province, China.
Department of Colorectal Surgery, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi Province, China.
Int J Colorectal Dis. 2025 Aug 5;40(1):171. doi: 10.1007/s00384-025-04965-z.
The purpose of this umbrella review was to systematically evaluate the effectiveness of therapeutic strategies for managing low anterior resection syndrome following sphincter-preserving surgery for rectal cancer and to provide evidence-based recommendations for clinical practice.
A systematic literature search was performed across five electronic databases. Two independent reviewers screened titles/abstracts, assessed full-text studies, and extracted data, with discrepancies resolved by consensus. The study adhered to AMSTAR-2 and GRADE frameworks for methodological quality and evidence certainty assessments.
Sixteen systematic reviews (including nine meta-analyses) published between 2018 and 2025 were analyzed, covering therapeutic strategies such as transanal irrigation, pelvic floor rehabilitation, sacral nerve stimulation, percutaneous tibial nerve stimulation, pelvic floor muscle training, and biofeedback therapy. For quality assessment, two studies were evaluated as moderate quality, five as low, and nine as critically low.
TAI and PFR are recommended as first-line therapies for LARS, while SNS or PTNS may be considered for refractory cases, especially those with predominant fecal incontinence. Future research should focus on standardizing protocols, improving patient compliance, and conducting high-quality randomized controlled trials to strengthen the evidence base.
本系统性综述的目的是系统评价直肠癌保肛手术后处理低位前切除综合征的治疗策略的有效性，并为临床实践提供循证建议。
在五个电子数据库中进行了系统的文献检索。两名独立评审员筛选标题/摘要、评估全文研究并提取数据，分歧通过协商解决。该研究遵循AMSTAR-2和GRADE框架进行方法学质量和证据确定性评估。
分析了2018年至2025年间发表的16项系统性综述（包括9项荟萃分析），涵盖经肛门冲洗、盆底康复、骶神经刺激、胫神经经皮刺激、盆底肌肉训练和生物反馈疗法等治疗策略。在质量评估中，两项研究被评估为中等质量，五项为低质量，九项为极低质量。
推荐经肛门冲洗（TAI）和盆底康复（PFR）作为低位前切除综合征（LARS）的一线治疗方法，而对于难治性病例，尤其是主要存在大便失禁的病例，可考虑骶神经刺激（SNS）或胫神经经皮刺激（PTNS）。未来的研究应专注于规范方案、提高患者依从性，并开展高质量的随机对照试验以加强证据基础。
