Continuous intraoperative monitoring of pelvic autonomic nerves during TME to prevent urogenital and anorectal dysfunction in rectal cancer patients (NEUROS): a randomized controlled trial

Kauff, Daniel W.; Kronfeld, Kai; Gorbulev, Stanislav; Wachtlin, Daniel; Lang, Hauke; Kneist, W.

doi:10.1186/s12885-016-2348-4

Cited by 24 publications

(18 citation statements)

References 21 publications

(14 reference statements)

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“…The study excluded patients undergoing abdominoperineal excision, Hartmann's procedure, and those with T4 rectal cancer, postoperative adjuvant chemoradiotherapy, or missing FU on ano(neo-)rectal function. Patients undergoing pIONM within the prospective randomized controlled multicenter trial "NEUROS" (ClinicalTrials.gov: NCT01585727) were also excluded [13].…”

Section: Participantsmentioning

confidence: 99%

Fecal incontinence after total mesorectal excision for rectal cancer—impact of potential risk factors and pelvic intraoperative neuromonitoring

et al. 2020

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Background: Fecal incontinence frequently occurs after total mesorectal excision for rectal cancer. This prospective study analyzed predictive factors and the impact of pelvic intraoperative neuromonitoring at different follow-up intervals. Methods: Fifty-two patients were included undergoing total mesorectal excision for rectal cancer, and 29 under control of pelvic intraoperative neuromonitoring. Fecal incontinence was assessed using the Wexner Score at 3 and 6 months after stoma closure (follow-ups 1 and 2) as well as 1 and 2 years after surgery (follow-ups 3 and 4). Risk factors were identified by means of logistic regression. Results: New onset of fecal incontinence was significantly lower in the neuromonitoring group at each follow-up (follow-up 1: 2 of 29 patients (7%) vs. 8 of 23 (35%), (p = 0.014); follow-up 2: 3 of 29 (10%) vs. 9 of 23 (39%), (p = 0.017); follow-up 3: 5 of 29 (17%) vs. 11 of 23 (48%), p = 0.019; follow-up 4: 6 of 28 (21%) vs. 11 of 22 (50%), p = 0.035). Non-performance of neuromonitoring was found to be an independent predictor for fecal incontinence throughout the survey. Neoadjuvant chemoradiotherapy was an independent predictor in the further course 1 and 2 years after surgery. Conclusions: Performance of pelvic intraoperative neuromonitoring is associated with significantly lower rates of fecal incontinence. Neoadjuvant chemoradiotherapy was found to have negative late effects. This became evident 1 year after surgery.

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Section: Participantsmentioning

confidence: 99%

Fecal incontinence after total mesorectal excision for rectal cancer—impact of potential risk factors and pelvic intraoperative neuromonitoring

et al. 2020

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“…After careful evaluation of full‐text papers 27 studies were excluded: 15 studies 23–37 did not evaluate FI assessment, six manuscripts 38–43 were just protocols, five were paediatric studies, 44–48 and one trial 49 had an inappropriate study design. Finally, 328 studies were included in our review: 306 studies…”

Section: Resultsmentioning

confidence: 99%

Tools for fecal incontinence assessment: lessons for inflammatory bowel disease trials based on a systematic review

et al. 2020

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Background Fecal incontinence is a disabling condition affecting up to 20% of women. Objective We investigated fecal incontinence assessment in both inflammatory bowel disease and non-inflammatory bowel disease patients to propose a diagnostic approach for inflammatory bowel disease trials. Methods We searched on Pubmed, Embase and Cochrane Library for all studies on adult inflammatory bowel disease and non-inflammatory bowel disease patients reporting data on fecal incontinence assessment from January 2009 to December 2019. Results In total, 328 studies were included; 306 studies enrolled non-inflammatory bowel disease patients and 22 studies enrolled inflammatory bowel disease patients. In non-inflammatory bowel disease trials the most used tools were the Wexner score, fecal incontinence quality of life questionnaire, Vaizey score and fecal incontinence severity index (in 187, 91, 62 and 33 studies). Anal manometry was adopted in 41.2% and endoanal ultrasonography in 34.0% of the studies. In 142 studies (46.4%) fecal incontinence evaluation was performed with a single instrument, while in 64 (20.9%) and 100 (32.7%) studies two or more instruments were used. In inflammatory bowel disease studies the Wexner score, Vaizey score and inflammatory bowel disease quality of life questionnaire were the most commonly adopted tools (in five (22.7%), five (22.7%) and four (18.2%) studies). Anal manometry and endoanal ultrasonography were performed in 45.4% and 18.2% of the studies. Conclusion Based on prior validation and experience, we propose to use the Wexner score as the first step for fecal incontinence assessment in inflammatory bowel disease trials. Anal manometry and/or endoanal ultrasonography should be taken into account in the case of positive questionnaires.

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“…Se realiza mediante electroestimulación intraoperatoria de los nervios autónomos y observación de un patrón de electromiografía del esfínter anal interno y manometría vesical. Actualmente, existe un estudio randomizado en curso que pretende evaluar el impacto de esta estrategia en los resultados funcionales intestinales y genitourinarios de los pacientes operados por cáncer de recto 52 .…”

Section: • Monitoreo Neurológico Intraoperatoriounclassified

Síndrome de la resección anterior baja: un alto precio del tratamiento del cáncer de recto

Gueregat

Larach

2019

Rev. cir.

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Low anterior resection syndrome: a high cost of rectal cancer treatment In the last 30 years, oncologic outcomes of rectal cancer treatment have been significantly improved due to multimodal management and the introduction of the concept of total mesorectum excision. Although the improvements in oncological treatment and surgical techniques are undeniable, multimodal treatment results in the onset of disorders of the intestinal, sexual and urinary function in a high proportion of these patients. Up to 90% of patients undergoing a low anterior resection refer bowel disorders such as fecal incontinence, urgency, increased frequency and fragmentation of defecation. These elements are included in an entity known as the low anterior resection syndrome and specific assessment tools have been designed recently, evidencing the high incidence and prevalence of this syndrome. In the present review, we update the pathophysiology, risk factors, clinical presentation, evaluation and the alternatives of prevention and treatment of low anterior resection syndrome.

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Continuous intraoperative monitoring of pelvic autonomic nerves during TME to prevent urogenital and anorectal dysfunction in rectal cancer patients (NEUROS): a randomized controlled trial

Cited by 24 publications

References 21 publications

Fecal incontinence after total mesorectal excision for rectal cancer—impact of potential risk factors and pelvic intraoperative neuromonitoring

Fecal incontinence after total mesorectal excision for rectal cancer—impact of potential risk factors and pelvic intraoperative neuromonitoring

Tools for fecal incontinence assessment: lessons for inflammatory bowel disease trials based on a systematic review

Síndrome de la resección anterior baja: un alto precio del tratamiento del cáncer de recto

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