Randomized Controlled Study On Prompting Low Anterior Resection Syndrome After Rectal Resection For Rectal Cancer By Electroacupuncture

BackgroundThe incidence of rectal cancer is high and on the rise in our country.With the development of surgical techniques and adjuvant therapy,sphincter-preserving resection for low or ultra-low rectal cancer has been widely carried out,which significantly improves the survival rate of patients.Low anterior resection syndrome(LARS)is a common clinical complication after sphincter-preserving resection for rectal cancer,the main manifestations are a constellation of bowel dysfunction syndromes including increased frequency of stool,stool urgency,fecal incontinence,emptying difficulties,et al.The incidence of these symptoms can be as high as 80%～90%and may last for a lifetime in some severe patients,seriously affecting the quality of life of patients after surgery,resulting in a great psychological burden.LARS is a challenge for many patients with rectal cancer after sphincter-preserving resection.At present,there are no clear guidelines and consensus on the diagnosis and treatment of LARS all over the world,it is urgent for rectal cancer comprehensive treatment to prompt the clinical symptoms and improve the quality of life.Section one:literature reviewsReview 1 Current status of modern medical research on LARSIn order to explore the current status of modern medical research on LARS,this study reviewed the literature related to LARS and summarized the definition,symptoms,cognition and evaluation,mechanism and treatment status of LARS.Review 2 Current status and rules of acupuncture and moxibustion in treating LARS Objective To explore and summarize the current status and rules of acupuncture and moxibustion in the treatment of LARS.Methods The clinical research reports of acupuncture and moxibustion treatment of LARS in CNKI,Wanfang database,VIP and PubMed databases were retrieved by computer,and the commonly used intervention selection,acupoint selection,treatment frequency,treatment course,observation indicators,and treatment results follow-up results,safety and so on were statistically analyzed.Results A total of 8 clinical research reports on acupuncture and moxibustion treatment of LARS were included in this review.Acupuncture and moxibustion were the main intervention measures,followed by acupuncture combined with other treatment methods.The most commonly used acupoints were Zusanli,Baliao,Tianshu,Zhong For Wan,Guanyuan,Qihai,Sanyinjiao,and Shangjuxu.Treatment was mostly once a day,and the total treatment time was most commonly 1 or 3 months.LARS score,Wexner fecal incontinence score,EORTC QLQ-CR30,QLQ-CR29 was commonly used as observation indicators.Acupuncture and moxibustion treatment of LARS was effectivein reducing the LARS score and Wexner fecal incontinence score of LARS patients,improving clinical symptoms such as bowel frequency,urgency,and tenesmus,and improving the EORTC QLQ-CR30 and QLQ-CR29 quality of life scale score.Follow-up periods were short,with the shortest being 1 month and the longest being 6 months,and no adverse safety events were reported.Conclusion Acupuncture and moxibustion is easy to operate,economical,safe and effective,and it is clinically used to improve the symptoms of LARS.At present,there are few literature reports on acupuncture and moxibustion treatment of LARS,and most of them are single-center and small-sample observational studies.Various forms of acupuncture such as needling,electroacupuncture,thumb-tack needles,and moxibustion was selected and Zusanli,Ba Liao,Tianshu,Zhongwan,Guanyuan,Qihai,Sanyinjiao,and Shangjuxu were commonly used for intervention.A certain advantages in terms of improving clinical symptoms and enhancing the quality of life had been reported.However,there is a lack of long-term efficacy observations,and high-quality randomized controlled clinical studies are still needed to further verify its efficacy.Section two:clinical studyObjective To compare the preliminary outcomes of electroacupuncture and transanal irrigation for prompting low anterior resection syndrome,and explore the selective advantage of electroacupuncture for LRAS,providing practical evidence for the clinical treatment selection for low anterior resection syndrome.Methods A randomized controlled clinical trial was conducted from October 2021 to December 2022 in the Department of proctology at Guang’anmen hospital affiliated to China academy of Chinese medical science.Patients with low anterior resection syndrome who met the inclusion criteria were randomly assigned to either the experimental group or the control group.The experimental group received electroacupuncture therapy,with needles inserted at the following acupoints:Shangliao,Ciliao,Zhongliao,Xialiao,Huiyang,Sanyinjiao,Zusanli,Tianshu,Shangwan,Zhongwan,Qihai,and Guanyuan.The needles were connected to an electronic acupuncture device at Shangliao,Ciliao,Zhongliao,Xialiao,Huiyang,Sanyinjiao,and Zusanli,and set to sparse and dense waves with a frequency of 3HZ and an output power of 0.1-1mA,gradually adjusted according to the patient’s tolerance.The treatment lasted 30 minutes and was administered three times per week for 12 weeks in total.The control group received transanal irrigation.Patients carried out transanal irrigation by themselves at home after receiving training and completing a tolerance test.The initial volume of the enema was based on the capacity of the patient’s first bowel movement,generally recommended to be 200ml.During the treatment,the volume was gradually increased,and the maximum volume should not exceed 1500ml.The intervention was administered three times per week for 3 months in total.Follow-up was conducted three months after the end of treatment.LARS score,Wexner incontinence score,and QLQ-C30 score were recorded before and after treatment,as well as during follow-up,and the results were analyzed and compared between the two groups.Results A total of 33 subjects were finally included in the study,with 18 in the experimental group and 15 in the control group.Due to the impact of the COVID-19 pandemic,3 patients in the experimental group dropped out at the initial stage of intervention.The final number of completed cases was 30,with 15 in the experimental group and 15 in the control group.The baseline data of the enrolled patients were collected and analyzed,and there were no significant differences between two groups in terms of gender,age,body mass index,smoking history,alcohol consumption history,family history of colorectal cancer,tumor pathological stage,tumor location,postoperative duration,anastomosis height,adjuvant radiotherapy and chemotherapy history,protective ileostomy,or time of stoma closure(p>0.05),indicating comparability between the two groups.At the end of the treatment,the LARS score and Wexner incontinence score in both groups were significantly lower than those before treatment(p<0.05),however,here was no significant difference in LARS score and Wexner incontinence score between the two groups(P>0.05).After intervention,the QLQ-C30 scores of general health level,physical function,role function,emotional function,cognitive function and social function of the experimental group and the control group were improved compared with those before intervention,and there were significant differences in general health level,role function,emotional function,cognitive function and social function(p<0.05),meanwhile,the scores of fatigue,nausea and vomiting,pain,shortness of breath,insomnia,loss of appetite,constipation,diarrhea and economic difficulties were lower than those before intervention,and there were significant differences in fatigue,nausea and vomiting,pain,insomnia,loss of appetite,constipation and diarrhea(p<0.05).Compared with the control group,there were significant differences in QLQ-C30 scores of general health level,role function,emotional function,cognitive function,social function,fatigue,pain,insomnia,loss of appetite,constipation and diarrhea(p<0.05),there was no significant difference in physical function,nausea and vomiting,shortness of breath and economic difficulty(P>0.05),either.There was no significant difference in the follow-up results between the two groups at the third month after treatment(p>0.05).Conclusion The research results indicate that both electro-acupuncture therapy and transanal irrigation intervention can improve the LARS score,Wexner incontinence score,and QLQ-C30 score of LARS patients,prompting the clinical symptoms of LARS and enhancing the quality of life.What’s more,the health status level,role function,emotional function,cognitive function,social function,fatigue,pain,insomnia,loss of appetite,constipation,and diarrhea dimensions in the QLQ-C30 score of patients with low anterior resection syndrome after electro-acupuncture therapy intervention have statistically significant differences.Patients with LARS after electroacupuncture therapy intervention have a higher quality of life,and electroacupuncture therapy has fewer adverse reactions and higher safety than transanal irrigation.It can be considered a conservative treatment selection for LARS.