Therapeutic strategies for low anterior resection syndrome: an umbrella review of systematic reviews.

IF 2.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

International Journal of Colorectal Disease Pub Date : 2025-08-05 DOI:10.1007/s00384-025-04965-z

Tingting Liu, Xueping Jiao, Congli Hu, Rui Su, Jiangfeng Dong, Qiaohong Niu

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引用次数: 0

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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前低位切除综合征的治疗策略：系统综述。

目的：本综述的目的是系统评估直肠癌保括约肌手术后低位前切除术综合征治疗策略的有效性，并为临床实践提供循证建议。方法：对5个电子数据库进行系统的文献检索。两名独立审稿人筛选标题/摘要，评估全文研究，提取数据，通过共识解决差异。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。结果：我们分析了2018 - 2025年间发表的16篇系统综述（包括9篇荟萃分析），涵盖了经肛门冲洗、盆底康复、骶神经刺激、经皮胫神经刺激、盆底肌肉训练和生物反馈治疗等治疗策略。对于质量评价，两项研究被评价为中等质量，五项为低质量，九项为极低质量。结论：TAI和PFR可作为LARS的一线治疗方法，而对于难治性病例，特别是以大便失禁为主的患者，SNS或PTNS可考虑。未来的研究应注重规范方案，提高患者依从性，开展高质量的随机对照试验，以加强证据基础。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Colorectal Disease 医学-外科

CiteScore

4.90

自引率

3.60%

发文量

206

审稿时长

3-8 weeks

期刊介绍： The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.