Colorectal cancer is one of the most common cancers affecting both men and women. Rectal cancers affecting the mid to low rectal cancers are particularly challenging, as most patients would like to maintain gastrointestinal continuity and avoid a permanent stoma. With a total mesenteric excision and neoadjuvant radiotherapy, long term survival following rectal cancer has been significantly improved.
However, following a low anterior resection and colorectal or coloanal anastomosis, low anterior resection syndrome and faecal incontinence are not uncommon and can significantly affect patient long-term quality of life. Patients suffer with difficulty to emptying the neo-rectum as well as faecal incontinence. These problems are difficult to manage. If symptoms cannot be controlled, then a permanent colostomy is required.
Antegrade enemas are a recognised successful treatment for paediatric patients with severe constipation. A recent study by Didailler et al reviews the use of antegrade enemas to manage anterior resection syndrome and faecal incontinence in patients after anterior resection for rectal cancer. The technique uses a cecostomy formed laparoscopically. Once formed, an enema can be given via the caecostomy. The enema then flows round the colon to help clear the colon and neo-rectum.
Investigators of this study found that an antegrade enema was a safe surgical option and significantly improved patients’ continence scores and gastrointestinal quality of life. There was also an improvement in the emptying of the neo-rectum. A colostomy was avoided in nearly 90% of patients.
This was a small single centre study. But it does present evidence that an antegrade enema can be an alternative option for those patients with faecal incontinence where other treatments have failed.
Article by Alexis Schizas on behalf of the Publications and Communications Committee
Didailler R et al. Antegrade Enema After Total Mesorectal Excision for Rectal Cancer: The Last Chance to Avoid Definitive Colostomy for Refractory Low Anterior Resection Syndrome and Fecal Incontinence. Dis Colon Rectum. 2018 Jun;61(6):667-672