Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

A pelvic floor rehabilitation program for patients with low anterior resection syndrome after sphincter-preserving surgery for colorectal cancer: a feasibility study  (#230)

Kin Yin Carol Chan 1 2 , Michael Suen 1 2 , Gemma Collett 1 , Susan Coulson 1 , Janindra Warusavitarne 3 , Janette Vardy 1 2
  1. The University of Sydney , Sydney, NSW, Australia
  2. Concord Repatriation General Hospital, Concord, NSW, Australia
  3. St. Mark's Hospital, London, UK

Aim: Low Anterior Resection Syndrome (LARS) is common after colorectal cancer (CRC) surgery.  We examined the feasibility and efficacy of a pelvic floor rehabilitation (PFR) program for CRC survivors with LARS surgery and treatment.

 

Method: Prospective, single-arm PFR pilot study. Eligibility criteria: sphincter-preserving anterior resection for CRC (+/- neoadjuvant/adjuvant treatment, +/- reversed temporary stoma); sustained bowel symptoms with LARS Score >20, minimum 6 months after surgery. The intervention was a 10-week supervised PFR program including: education, biofeedback, pelvic floor muscle training, home exercises. The program was conducted in outpatient clinic with/without telehealth (COVID-19 adaptations). Primary outcome: PFR program adherence and compliance. Secondary outcomes: bowel, bladder, sexual dysfunction; quality-of-life (QOL); anorectal physiology parameters. Descriptive data analysis and Chi-squared test were undertaken.

 

Results: A total of 15 participants (Mean age 61, 44-81 years; Male = 8), 8 participants received hybrid physical/telehealth treatment. Cancer type: rectal 13; sigmoid 2. Surgery: high (1), low (3) and ultralow (11) anterior resection. Previous temporary stoma: 11/15, mean duration 4.8 months (range 2-10). Five had neoadjuvant chemo/radiotherapy, 7 adjuvant chemotherapy. Time since bowel continuity restored: mean 19.5 (range 7-60) months. One participant withdrew after week 2; 14/15 included in final analysis. Intervention adherence was high: 100% attendance; 96% self-reported home exercise program completion. High satisfaction level rating: excellent (60%), very good (27%). After PFR, faecal incontinence and frequency reduced (p<0.05). LARS (95%CI 6.1,18 p<0.001), MSKCC-BFI bowel function (95%CI -14.4,-4.2 p=0.01), female bladder function (95%CI1.1,8.6 p=0.019) scores improved. Faecal incontinence QOL score improved: +0.6 (95%CI -0.9,-0.2 p<0.001). Anorectal physiology parameters: mean squeeze pressure, push relaxation and rectal sensory volume thresholds all increased: 9.5%, 70%, 37% respectively (p<0.05).  

Conclusion: A PFR program is feasible and highly adhered to by CRC survivors with LARS. PFR improved bowel symptoms, QOL, and anorectal physiological function.