Efficacy of pelvic floor rehabilitation for bowel dysfunction after anterior resection for colorectal cancer: a systemat
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REVIEW ARTICLE
Efficacy of pelvic floor rehabilitation for bowel dysfunction after anterior resection for colorectal cancer: a systematic review K. Y. C. Chan 1,2 & M. Suen 2,3 & S. Coulson 2 & Janette L. Vardy 1,2 Received: 15 August 2020 / Accepted: 13 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Bowel dysfunction is common after anterior resection for colorectal cancer (CRC). Pelvic floor rehabilitation (PFR) may improve functional outcomes after surgery. This review aimed to evaluate the efficacy of PFR for patients with bowel symptoms after anterior resection. Methods MEDLINE, CINHAL, PUBMED, EMBASE, Scopus, PsycINFO, Web of Science, PEDRO and Cochrane Library were searched from inception to June 2019. A final search was performed on 11 July 2020. Randomised controlled trials (RCTs), cohort studies, case-control studies and case series of bowel dysfunction after CRC surgery and PFR were eligible for review. Outcome measures were bowel function changes measured by patient-reported outcomes and manometric measurement. Risk of bias assessments using Methodological Index for Non-Randomized Studies (MINORS) tool and Newcastle Ottawa Scale (NOS) were conducted. Results Eleven trials met eligibility criteria: four retrospective studies and seven prospective, non-randomised controlled studies. A total of 516 participants were included, of which 455 received PFR. Functional outcomes were measured by bowel functional outcome questionnaires, patient diary, anorectal manometry and three studies measured quality of life. Faecal incontinence was improved in seven studies, and bowel frequency also decreased in five studies. The mean MINORS score was 10 (8–13) out of 16 in non-comparative groups and 18 (16–22) out of 24 in comparative groups; the NOS was 4.2 (3–7) out of 9. The overall risk of bias was high in most studies. Conclusions PFR appears to be beneficial for improving bowel function after anterior resection for CRC. However, the studies included had methodological limitations, so further investigation on the effectiveness of PFR is warranted. Keywords Colorectal cancer . Bowel dysfunction . Anterior resection . Pelvic floor . Rehabilitation . Biofeedback
Introduction Colorectal cancer (CRC) is the third most commonly diagnosed cancer and accounts for 10% of all cancers worldwide [1]. There has been a shift in CRC management paradigms in
* Janette L. Vardy [email protected] 1
Concord Cancer Centre, Concord Repatriation & General Hospital, Hospital Road, Sydney, NSW 2139, Australia
2
Faculty of Medicine and Health, University of Sydney, Sydney, Australia
3
Department of Colorectal Surgery, Concord Repatriation & General Hospital, Concord, NSW 2139, Australia
the past two decades which has resulted in decreased mortality. Prevention, screening, surveillance measures and a multimodal treatment approach to CRC have improved survival, achieving a 5-year survival rate between 60 and 70% internationally [2]. The evolution of diagnostic technology and surgical
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