S Hou, S Zhang, X Zheng, X Wu, H Zhu, K Shen, Z Gao, C Zhong, Y Ye
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引用次数: 0
Abstract
Background: The therapeutic value of transanal irrigation (TAI) for low anterior resection syndrome (LARS) has not been fully confirmed. This study aims to evaluate the efficiency of TAI in improving bowel function and quality of life (QoL) following sphincter-preserving resections (SPRs) for rectal cancer through a systematic review and meta-analysis of randomized controlled trials (RCTs).
Methods: The protocol was registered in PROSPERO (CRD42024598219). PubMed, Embase, Web of Science, Cochrane Library, CNKI, and WanFang databases were systematically searched for RCTs comparing TAI with conservative treatments for LARS published before December 2024. Outcomes included pooled risk ratios (RRs) for dichotomous variables and weighted mean differences (WMDs) for continuous variables, calculated using Review Manager 5.4.1 with 95% confidence intervals (CIs). P < 0.05 was considered statistically significant. The I2 test was used to assess heterogeneity.
Results: Among 123 initially identified studies, six RCTs involving 317 patients were included. Meta-analysis demonstrated that the TAI group exhibited significantly lower LARS scores (WMD = -10.35, 95% CI [-15.92, -4.78], P < 0.01). The TAI group demonstrated significantly better outcomes across all five LARS subscales compared to controls, including flatus incontinence (WMD = -0.92; 95% CI [-1.30, -0.54]; P < 0.01), liquid stool incontinence (WMD = -0.83; 95% CI [-1.07, -0.59]), frequency (WMD = -1.33; 95% CI [-1.95, -0.72]; P < 0.01), stool clustering (WMD = -4.89; 95% CI [-5.90, -3.88]), and urgency (WMD = -5.35; 95% CI [-7.12, -3.58]). There was also a significant difference in Wexner score (WMD = -2.78, 95% CI [-4.13, -1.42], P < 0.01). However, no significant differences were observed in SF-36 mental (WMD = 7.27, 95% CI [-1.61,16.15], P = 0.11) or physical component scores (WMD = 6.97, 95% CI [-1.26,15.19], P = 0.10). Heterogeneity was substantial for LARS score analysis (I2 = 86%) but resolved in subgroup analyses.
Conclusion: TAI significantly improves bowel function in patients with LARS, as evidenced by reduced LARS and Wexner scores. However, its impact on QoL remains inconclusive. Large-scale RCTs with extended follow-up periods are warranted to validate long-term clinical benefits.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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