Vall d'Hebron shows the benefits of sacral neuromodulation to improve the symptoms of low anterior resection syndrome

Rectal resection is one of the usual treatments for rectal cancer, associated with chemotherapy or radiotherapy. This surgery, however, causes numerous intestinal sequelae, especially faecal incontinence, which have a great impact on the quality of life of patients. The Colorectal Surgery Unit of Vall d'Hebron University Hospital and the General Surgery group of Vall d'Hebron Research Institute (VHIR) have demonstrated that stimulation of the sacral nerves using electrodes, a technique known as sacral neuromodulation, improves symptoms in these patients. The study, led by Dr. Franco Marinello and Dr. Eloy Espín, has been published in the journal Diseases of the Colon & Rectum and received the award for best oral communication at the American Society for Colorectal Surgery (ASCRS) Congress last June in Seattle (USA).

The study, which also involved the University Hospital of Bellvitge and the University Hospital Dr. Josep Trueta in Girona, focused on the study of sacral neuromodulation, which consists of electrical stimulation of the sacral nerves with the aim of restoring the functional activity of the pelvic floor. The technique has two phases, the first of which consists of the implantation of an electrode in a sacral foramen and where the clinical improvement is evaluated in 2-3 weeks with an external battery. If the test is positive, the patient moves on to a second phase in which a generator similar to a pacemaker is implanted.

Sacral neuromodulation is a minimally invasive technique that improves urinary and defecation dysfunctions. However, until now, there have been no controlled studies supporting its use in low anterior resection syndrome (LARS), so it was only recommended as a last option when more conservative measures were not effective.

The current study was carried out on 46 patients who had undergone rectal resection and had symptoms of severe LARS according to a specific scale. "This pathology encompasses all alterations of bowel function, which ultimately impairs the patient's quality of life. The therapeutic approach to this syndrome is complex and not very standardised, so studies like this one open new therapeutic options", explains Dr. Franco Marinello, associate of the Colon and Rectal Surgery Unit at Vall d'Hebron University Hospital and researcher of the General Surgery group at VHIR.

After the test phase, the implanted participants were classified into two groups. In one group, patients received sacral neuromodulation for one month and then the battery was switched off to compare the results. The other group underwent the opposite procedure: they initially started with the battery switched off and then switched on. After this phase, the generator was switched on permanently.

The results showed that sacral neuromodulation can palliate the symptoms of LARS in up to 80% of patients. "Our study has shown that this technique can improve the quality of life of these patients, for example, by reducing faecal incontinence, urgency episodes and frequency of going to the restroom", says Dr. Eloy Espín, head of the Colon and Rectal Surgery Unit at Vall d'Hebron University Hospital and principal investigator of the General Surgery group at VHIR.

Future research will work to identify which patients can benefit the most from this therapy. "It represents a change in clinical practice, in order for sacral neuromodulation to stop being considered the last option and to be considered as an alternative at an earlier stage", concludes Dr. Marinello, who also stresses the need to take into account patients' preferences so that they can take a leading role in their clinical decisions.

Image: Dr. Eloy Espin & Dr. Franco Marinello