A Randomized Controlled Clinical Trial of Transanal Irrigation Versus Conservative Treatment in Patients With Low Anterior Resection Syndrome After Rectal Cancer Surgery

Abstract

The aim of the study was to evaluate transanal irrigation (TAI) as a treatment for low anterior resection syndrome (LARS). Background: LARS is a bowel disorder that is common after sphincter preserving rectal cancer surgery. Despite symptomatic medical treatment of LARS many patients still experience bowel symptoms that may have a negative impact on quality of life (QoL). TAI is a treatment strategy, of which the clinical experience is promising but scientific evidence is limited. Materials and Methods: A multicenter randomized trial comparing TAI (intervention) with conservative treatment (control) was performed. Inclusion criteria were major LARS, age above 18 years, low anterior resection with anastomosis and a defunctioning stoma as primary surgery, > 6 months since stoma reversal, anastomosis without signs of leakage or stricture, and no signs of recurrence at 1-year follow-up. The primary endpoint was differences in bowel function at 12-month followup measured by LARS score, Cleveland Clinic Florida Fecal Incontinence Score, and 4 study-specific questions. The secondary outcome was QoL. Results: A total of 45 patients were included, 22 in the TAI group and 23 in the control group. Follow-up was available for 16 and 22 patients, respectively. At 12 months, patients in the TAI group reported significantly lower LARS scores (22.9 vs 32.4; P = 0.002) and Cleveland Clinic Florida Fecal Incontinence Score (6.4 vs 9.2; P = 0.050). In addition, patients in the TAI group also scored significantly higher QoL [8 of 16 European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) QoL aspects] compared with the control group. Conclusions: The results confirm our clinical experience that TAI reduces symptoms included in LARS and improves QoL.

‘He's a surgeon, like I'm not going to waste his time’: interviews to determine healthcare needs of people with low anterior resection syndrome after rectal cancer surgery

“…Changing dietary intake to reduce symptoms was common amongst participants, as previously described [25], but clinician support may be required to enable a healthy diet [26]. There are other potentially useful interventions described in some expert guidelines [11], including transanal irrigation [27]. Participants wanted information but did not always follow it, instead accepting the consequent symptoms and using management strategies to mitigate effects.…”

Low anterior resection syndrome

“…Pieniowski et al demonstrated in a multicenter randomized trial that transanal irrigation reduced LARS scores and quality of life was improved. 51 Another study evaluated 22 patients with predominantly major LARS with a median score of 39 and found that after 12 months of regular transanal irrigation, 90% of patients were classified as having "no syndrome." 52 If symptoms persist despite intensive diet modification and minimal success with transanal irrigation, pelvic floor rehabilitation can be utilized.…”

“…The effect allows for a mechanical wash out which then allows for the patient to have time before needing to defecate again. Pieniowski et al demonstrated in a multicenter randomized trial that transanal irrigation reduced LARS scores and quality of life was improved 51 . Another study evaluated 22 patients with predominantly major LARS with a median score of 39 and found that after 12 months of regular transanal irrigation, 90% of patients were classified as having “no syndrome.” 52 …”

Low anterior resection syndrome

“…A multicenter randomized trial to evaluate the transanal irrigation as a treatment for LARS confirmed that it reduces symptoms in LARS and improves the quality of life. 46 However, the study was performed with a small number of participants and could involve some potential complications such as The most commonly prescribed, But has some safety issues 5HT receptor antagonist + + RCT [41] case-series [40] Emerging, But needs more studies Pelvic floor muscle training + ± RCTs [43,44] systematic reviews [42] Controversies for outcomes Long-term effects have not been proven…”