Effectiveness of Biofeedback Therapy in the Treatment of Anterior Resection Syndrome After Rectal Cancer Surgery

BACKGROUND: Although anterior resection syndrome commonly occurs after anal sphincter-saving surgery, no standard treatment option is currently available. OBJECTIVE: The aim of the present study was to evaluate the clinical effectiveness of biofeedback in patients with anterior resection syndrome after sphincter-saving surgery for rectal cancer. DESIGN: This study was a retrospective review of data collected during the course of treatment. SETTINGS: Patients were treated at a teaching hospital (Asan Medical Center) in Seoul, Korea, from January 2003 through December 2008. PATIENTS: Patients who received biofeedback therapy for anterior resection syndrome after rectal cancer surgery were included. MAIN OUTCOME MEASURES: The Cleveland Clinic Florida fecal incontinence score, number of bowel movements per day, a visual analog scale for assessing patient satisfaction, and anorectal manometry were used to assess outcome of biofeedback treatment. RESULTS: After biofeedback therapy, significant improvements were observed in fecal incontinence score (P < .001), number of bowel movements (P < .001), and anorectal manometry data (maximum resting pressure, P = .010; maximum squeeze pressure, P = .006; rectal capacity, P = .003). Compared with patients who started biofeedback treatment less than 18 months after surgery, those who started biofeedback at 18 months or longer after surgery showed greater improvements in fecal incontinence score (P = .032). Only patients with fecal incontinence as the primary symptom showed significant improvements in all variables, including fecal incontinence score, P < .001; defecation frequency, P < .001; and anorectal manometry (maximum resting pressure, P = .027; maximum squeeze pressure, P = .021; rectal capacity, P = .004). Patients who received radiation therapy in addition to surgery reported a significantly higher satisfaction score than those receiving surgery alone (P = .041). LIMITATIONS: This is a nonrandomized retrospective study. Anorectal manometry was not regularly performed in all patients. CONCLUSIONS: Biofeedback therapy produced significant clinical benefits for patients with severe fecal incontinence and may be an effective treatment for patients with anterior resection syndrome after surgery for rectal cancer.