Background and Objective: 

Total mesorectal excision (TME) for rectal cancer (RC) often results in significant bowel symptoms, commonly known as low anterior resection syndrome (LARS). Although pelvic floor muscle training (PFMT) is recommended in noncancer populations for treating bowel symptoms, this has been scarcely investigated in RC patients. The objective was to investigate PFMT effectiveness on LARS in patients after TME for RC.

Methods: 

A multicenter, single-blind prospective randomized controlled trial comparing PFMT (intervention; n=50) versus no PFMT (control; n=54) 1 month following TME/stoma closure was performed. The primary endpoint was the proportion of participants with an improvement in the LARS category at 4 months. Secondary outcomes were: continuous LARS scores, ColoRectal Functioning Outcome scores, Numeric Rating Scale scores, stool diary items, and Short Form 12 scores; all assessed at 1, 4, 6, and 12 months.

Results: 

The proportion of participants with an improvement in LARS category was statistically higher after PFMT compared with controls at 4 months (38.3% vs 19.6%; P=0.0415) and 6 months (47.8% vs 21.3%; P=0.0091), but no longer at 12 months (40.0% vs 34.9%; P=0.3897). Following secondary outcomes were significantly lower at 4 months: LARS scores (continuous, P=0.0496), ColoRectal Functioning Outcome scores (P=0.0369) and frequency of bowel movements (P=0.0277), solid stool leakage (day, P=0.0241; night, P=0.0496) and the number of clusters (P=0.0369), derived from the stool diary. No significant differences were found for the Numeric Rating Scale/quality of life scores.

Conclusions: 

PFMT for bowel symptoms after TME resulted in lower proportions and faster recovery of bowel symptoms up to 6 months after surgery/stoma closure, justifying PFMT as an early, first-line treatment option for bowel symptoms after RC.

中文翻译：

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盆底肌训练对低位前切除综合征的作用：一项多中心随机对照试验

背景与目的： 

直肠癌(RC)的全直肠系膜切除术 (TME)通常会导致明显的肠道症状，通常称为低位前切除综合征 (LARS)。尽管在非癌症人群中推荐使用盆底肌肉训练 (PFMT) 来治疗肠道症状，但这在 RC 患者中几乎没有进行过研究。目的是研究 PFMT 对 RC 后 TME 患者 LARS 的有效性。

方法： 

进行了一项多中心、单盲前瞻性随机对照试验，比较了 TME/造口闭合后 1 个月的 PFMT（干预；n=50）与无 PFMT（对照；n=54）。主要终点是 4 个月时 LARS 类别改善的参与者比例。次要结果是：连续 LARS 评分、结肠直肠功能结果评分、数字评分量表评分、大便日记项目和 Short Form 12 评分；均在 1、4、6 和 12 个月时进行评估。

结果： 

在 4 个月（38.3% 对 19.6%； P = 0.0415）和 6 个月（47.8% 对 21.3%；P = 0.0091）与对照组相比，PFMT 后 LARS 类别改善的参与者比例在统计学上更高，但不再是12 个月时（40.0% 对 34.9%；P = 0.3897）。以下次要结果在 4 个月时显着降低：LARS 评分（连续，P = 0.0496）、结肠直肠功能结果评分（P = 0.0369）和排便频率（P = 0.0277）、固体粪便渗漏（天，P = 0.0241；夜，P = 0.0496）和簇数（P=0.0369），来源于大便日记。数值评定量表/生活质量评分未发现显着差异。

结论： 

TME 后肠道症状的 PFMT 导致手术/造口关闭后长达 6 个月的肠道症状比例较低且恢复较快，这证明 PFMT 是 RC 后肠道症状的早期一线治疗选择。