Evaluating the clinical application and effect of acupuncture therapy in anal function rehabilitation after low-tension rectal cancer surgery

Abstract

BACKGROUND

According to the indexes of serum and anal function, acupuncture therapy was applied to patients with low rectal cancer in order to avoid the occurrence of anal incontinence and reduce complications.

AIM

To explore the clinical application and evaluate the effect of acupuncture therapy for anal function rehabilitation after low-tension rectal cancer surgery.

METHODS

From the anorectal surgery cases, we selected 120 patients who underwent colorectal cancer surgery between January 2020 and December 2022 and randomly divided them into a control group (n = 60), observation group (n = 60), and control group after surgery for lifestyle intervention (including smoking cessation and exercise), dietary factor adjustment, anal movement, and oral loperamide treatment. The serum levels of motilin, 5-hydroxytryptamine, and vasoactive intestinal peptide (VIP), Wexner score for anal incontinence, and incidence of complications were compared between groups.

RESULTS

After treatment, the VIP and 5-hydroxytryptamine levels in the observation group were lower than those in the control group (P < 0.05). The motilin level was higher than that in the control group (P < 0.05). Postoperative anal incontinence was better in the observation group than in the control group (P < 0.05). The incidence of complications in the observation group was 6.67%, which was significantly lower than that in the control group (21.67%; P < 0.05).

CONCLUSION

Acupuncture therapy has a positive effect on the rehabilitation of anal function after low-tension rectal cancer surgery; it can effectively help to improve the serum indices of patients, avoid the occurrence of anal incontinence, and reduce the incidence of complications. Popularizing and applying it will be valuable.

Key Words: Acupuncture therapy, Low pull rectal cancer, Anal function rehabilitation, Serum indicator, Wexner score

Core Tip: Acupuncture therapy post low-tension rectal cancer surgery improves serum markers, reduces anal incontinence, and lowers complication rates. Its application is valuable for enhancing anal function recovery.

INTRODUCTION

Against the backdrop of the new era, people’s eating habits and lifestyles have changed greatly, and people have gradually begun to stay up late, binge eat, and binge drink. These habits affect their health. Currently, the incidence of rectal cancer in China is high, and the disease is younger. Rectal cancer accounts for more than 50% of all intestinal tumors. Low rectal cancer is a common type of cancer that affects health and endangers life[1,2]. Presently, surgery is the first-choice treatment for low rectal cancer.

Low-anterior sphincter-preserving surgery for rectal cancer has attracted much attention in this field because of its advantages, and its applications are increasing. However, anal dysfunction, such as defecation frequency, incontinence, urgent defecation, emptying disorder, and inability to distinguish defecation from exhaust, is prone to occur after low anus-preserving surgery for rectal cancer, which affects the prognosis[3]. Western medicine is based on symptomatic treatment strategies and routine interventions, and can achieve a certain short-term effect. However, the long-term effect is not ideal; by treating the symptoms rather than the root cause, the patient’s pain is aggravated, resulting in poor outcomes.

Traditional Chinese medicine states that “the corporeal door is also the cause of the five zang organs”. The anus is heaving and distension, and the abnormal functions of the anus and rectum cannot be solely responsible for the corporeal door. The rise and fall of the five zang organs, deficiency and excess, and birth and control should be taken into account[4]. In low pull rectal cancer surgery, many patients experience anal dysfunction, which causes them discomfort during the later rehabilitation process. Without timely intervention and scientific, effective treatment measures, patients are highly likely to develop various complications. Among the treatment options, acupuncture has significant advantages, as it can be used to stimulate the corresponding acupoints to different degrees, resolve obstructed meridians, regulate the coordination of the five zang organs, and promote the return of normal anal function[5]. Thus, this study focused on applying acupuncture therapy in anal function rehabilitation after low-tension rectal cancer surgery. The findings are reported herein.

MATERIALS AND METHODS

General information

The study included 120 patients who underwent rectal cancer surgery. The control group included 60 participants, with a male:female ratio of 38:22 and mean age of 63.70 years ± 3.24 years (range, 61-83 years). The observation group comprised 60 participants, including 36 males and 24 females with a mean age of 64.10 years ± 3.36 years (range, 60-85 years). The general data of the two groups were consistent with the comparison principle (P > 0.05), which had research value.

Inclusion criteria: (1) A clinical diagnosis of low rectal cancer; (2) imaging examination findings that showed that the liver, lung, and other important organs were not affected by cancer cells; (3) abnormal anal function; (4) a normal mental state, cognitive ability, and ability to communicate; and (5) patients and their family members who were informed of the study and signed the consent form to confirm this.

Exclusion criteria: (1) A previous medical history of cardiovascular disease, or diseases of the liver, kidney, or blood systems; (2) lung, breast, gastric cancer, or other malignant tumors; (3) poor postoperative recovery with many serious complications; and (4) an abnormal mental state, cognitive ability, or ability to communicate.

Methods

The control group underwent lifestyle interventions (including smoking cessation and exercise), dietary factor changes, levator ani exercises, and oral loperamide treatment. On this basis, the observation group was administered acupuncture treatment, which was performed by the same acupuncturist. The acupuncturist considered the prescribed acupoint positioning as the reference point, defined the standard acupuncture depth, and accordingly performed the acupuncture. The selection of prescribed acupoints included the Zusanli (bilateral), Shangjuxu (bilateral), Neiguan (bilateral), and Hegu (bilateral) points. The patient was informed of the need to maintain the supine position so that they could adjust the position in good time. The whole body was in a relaxed state, and thorough disinfection was performed. Acupuncture was extended to the Zusanli (ST 36) and Shangjuxu (ST 37) points, and routine positioning was performed according to the patient’s actual situation. The doctor used a 0.3 mm × 75.0 mm needle to slowly penetrate downward, and the depth was controlled within a reasonable range, that is, 1-2 cun, until the patient felt soreness and bloating. Using the Neiguan (PC 6) and Hegu (LI 4) points as the operating points, acupuncture was performed according to the appropriate strength, with routine positioning. The 0.3 mm × 40.0 mm needle was prepared and slowly inserted along the lower end position. The needle was inserted to a depth of between 0.5 cun and 1.0 cun, until the patient felt soreness and bloating. Acupuncture points are based on qi; thus, the strength of acupuncture delivered to each acupoint was performed as appropriate. Insertions using a rotating technique are a key part of acupuncture: The needles were inserted into each acupuncture point for approximately 30 min with a needle frequency of 1 time/10 min, with a row needle number in three times, for approximately 10 s each time. Acupuncture was not performed on the day of surgery, but was initiated on the first day after surgery. Acupuncture was performed for four days according to the above requirements.

Indicators of observation

(1) The serum levels of motilin, 5-hydroxytryptamine, and vasoactive intestinal peptide (VIP) were compared between the two groups; (2) the Wexner scoring system for anal incontinence was used to determine the degree of the patients’ anal incontinence. The frequency of anal incontinence was as follows: Never, 0 times; rarely, once a month; sometimes, anal incontinence once a week; often, less than once a day but once or more a week; and always, once or more a day and was scored as 0, 1, 2, 3, and 4 points, respectively. Stool characteristics (including solid, liquid, and gas), pad use, and lifestyle changes were recorded; and (3) the incidence of complications, including abdominal distension and pain, incision infection, anastomotic leakage, and adhesive intestinal obstruction, was compared between the two groups.

Statistical analysis

The SPSS.23 statistical software was used to analyze the data. The clinical measurement data and count data are expressed as (mean ± SD). The chi-square and t-tests were carried out in sequence.

RESULTS

Comparison of VIP, motilin, and 5-hydroxytryptamine

The levels of VIP and 5-hydroxytryptamine in the observation and control groups were lower than those before treatment, and the levels in the observation group were lower than those before treatment (P < 0.05). Compared to those before treatment, the levels of motilin in the observation and control groups increased, and that of the observation group was substantially higher (P < 0.05), as shown in Table 1.

Table 1 Comparison of changes in serum vasoactive intestinal peptide, motilin, and 5-hydroxytryptamine before and after treatment between the two groups (mean ± SD, pg/mL).

Indicator		Control (n = 60)	Observation (n = 60)	t value	P value
Vasoactive intestinal peptide	Before treatment	41.72 ± 10.85	41.80 ± 10.44	0.041	0.967
	After treatment	34.64 ± 6.80	27.83 ± 6.53	5.595	0.000
Motilin	Before treatment	154.71 ± 43.90	158.08 ± 44.60	0.417	0.677
	After treatment	198.38 ± 37.61	234.82 ± 42.64	4.964	0.000
5-hydroxytryptamine	Before treatment	320.70 ± 58.91	322.61 ± 60.83	0.175	0.862
	After treatment	263.65 ± 52.74	210.37 ± 48.27	5.773	0.000

Comparison of Wexner scores for anal incontinence

The Wexner score for postoperative anal incontinence was higher in the observation group than that in the control group (P < 0.05; Table 2).

Table 2 Comparison of postoperative anal incontinence between the two groups (mean ± SD, score).

Indicator		Control (n = 60)	Observation (n = 60)	t value	P value
Wexner score for anal incontinence	One month after surgery	10.5 ± 1.4	12.0 ± 1.8	5.095	0.000
	Three months after surgery	8.5 ± 0.8	9.8 ± 1.0	7.863	0.000
	Six months after surgery	7.0 ± 1.1	8.6 ± 1.1	7.967	0.000
	Twelve months after surgery	5.3 ± 1.3	6.0 ± 1.4	2.838	0.005

Comparison of complication rates

The incidence of complications in the observation group was 6.67%, which was considerably lower than that in the control group (21.67%; P < 0.05; Table 3).

Table 3 Comparison of postoperative complications between the two groups.

Indicator		Control (n = 60)	Observation (n = 60)	t value	P value
Complications	Abdominal distension and pain	4	2	-	-
	Incision infection	3	1	-	-
	Anastomotic leak	4	1	-	-
	Adhesive intestinal obstruction	2	0	-	-
	Overall incidence	13 (6.67)	4 (21.67)	5.551	0.018

DISCUSSION

Anal dysfunction after low rectal cancer surgery has many disadvantages, and its impact is substantial. For example, the frequency of defecation is abnormal after surgery, ranging from 5 times or more to 10 or even more than 20 times; this seriously affects postoperative recovery, and the physical and mental health of patients. The main reasons for abnormal defecation are anastomosis and position of the anus. A means to improve the outcome of this disease deserves attention[6,7]. Low rectal cancer has a high incidence of postoperative anal function. Focus in the field of related medical attention, and intensify the study of disease, research from multiple perspectives, and the direction of Chinese and western medicine, the results of the current study show that with a basis of conventional Western medicine therapy, the use of acupuncture as an auxiliary treatment yields remarkable effects on the symptoms of anal dysfunction.

The results of this study showed that, after treatment, VIP and 5-hydroxytryptamine levels in the observation and control groups were lower than those before treatment, and that those in the observation group were lower than before treatment (P < 0.05). These results indicated that acupuncture therapy had a positive effect on reducing VIP and 5-hydroxytryptamine levels in patients. The levels of motilin in the observation and control groups were higher than those before treatment, and the level of motilin in the observation group was higher than that before treatment (P < 0.05). Thus, acupuncture therapy provided an important means of improving the motilin levels of patients. The reason for these changes is that, although Western surgical medicine can achieve tumor resection, turbidity and toxicity in the body are not eliminated. After surgery, patients’ qi is less positive, and effectively eliminating the turbidity and toxicity is difficult. Continuing turbidity and toxicity in the body affects the balance of the five zang organs, leading to the appearance of many anal symptoms[8,9]. Acupuncture therapy is an effective method to improve the anal function of patients, anus week as point. The effects of acupuncture on the corresponding nerves prompts anal function to be restored in a shorter time. However, the effect is not significant in terms of the specification path[10]. Therefore, in the current study, the theory of turbidity and toxicity were fully considered. Consequently, acupuncture and moxibustion therapy were administered for deficiency and excess in patients who underwent low-tension rectal cancer surgery. The acupoints for the acupuncture were mainly selected to eliminate turbidity and toxins because the VIP, 5-hydroxytryptamine, and motilin levels of the patients often show abnormal states after surgery. Therefore, the patient’s serum indices improved.

In the comparison of postoperative Wexner scores for anal incontinence between the two groups, the observation group had a higher score than the control group (P < 0.05). This result indicated that the administration of acupuncture therapy effectively relieved the symptoms of anal incontinence. Many factors can affect the intestinal function of patients with low rectal cancer after surgery, among which the two key factors are surgical operation and the use of anesthetic drugs[11]. In Western medicine, drugs with intestinal decompression functions, such as cisapride and domperidone, are usually the first choice. However, these drugs have obvious adverse reactions, and providing safe and reasonable support for clinical treatment is challenging[12]. Recently, acupuncture with moxibustion has been widely used after surgery as an alternative therapy to improve patients’ gastrointestinal function. This therapy resolves intestinal dysfunction, and its efficacy has been recognized by patients and medical staff[13]. From the perspective of traditional Chinese medicine, postoperative intestinal dysfunction is a common phenomenon that mainly manifests as the obstruction of fu qi and the lack of sufficient positive qi in the body after surgery. This condition leads to the problematic rise and fall of the middle coke qi machine. However, acupuncture can unblock and regulate the intestine as well as unblock the qi machine. The intestinal function of patients with low rectal cancer after surgery is different from that under normal conditions, which is consistent with the intestinal obstruction and intestinal knot of traditional Chinese medicine. The theory of traditional Chinese medicine is that surgery is an injury of the golden blade. The impact of surgery on the skin, flesh, and blood vessels prevents the qi and blood of the body from flowing smoothly and increases the problem of obstructed meridians[14]; thus, improving the intestinal function in a short period is difficult. The Zusanli (ST 36), Shangjuxu (ST Juxu), Tianshu (ST 25), and Neiguan (PC 6) points are acupoints commonly used for postoperative intestinal function recovery. The efficacy of the Zusanli point is recognized in clinical practice, for example, the stomach invigorating the spleen and regulating the intestines and bowel organs. Digestive diseases in patients are often improved through the Zusanli acupoint[15]. Under the action of the Zusanli acupoint, the intestinal blood flow of patients can flow in a reasonable position and stimulate sufficient statins, the regulatory function of motilin is improved under the influence of nitric oxide and angiotensin, and slow peristalsis is avoided. The Shangjuxu acupoint is the lower He-sea point of the large intestine, the acupoint at which the qi of the bowels is concentrated. It is also commonly used in the treatment of large bowel diseases. The colonic nervous system can be affected by the upper Juxu to reduce patient discomfort. However, the Tianshu point is more closely related to intestinal function. These two acupoints can be regulated at different levels. The Neiguan (PC 6) acupoint is the collateral point of the pericardial meridian of the Hand-Jueyin. Acupuncture at this point is also very important, as it can effectively strengthen endocrine function, especially after the combined use of adrenaline and vasopressin, and reduce the secretion of gastric acid over time[16,17]. However, in the present study, this acupoint was not selected because the distance between the acupoint and the wound was too short to avoid infection to the wound. In addition, Hegu is the original point of the large intestine meridian of the Hand-Yangming, which can support the flow of qi and blood in the large intestine meridian. Therefore, the symptoms of anal incontinence in patients with rectal cancer improved considerably after treatment with this acupoint.

The results of this study showed that the incidence of complications was different between the two groups, with a lower incidence noted in the observation group than in the control group (P < 0.05). This finding indicated that acupuncture therapy effectively reduced the possibility of abdominal distension and pain, prevented incision infection, and increased the difficulty of postoperative rehabilitation; the use of acupuncture therapy also effectively reduced the incidence of anastomotic leakage. Acupuncture has a positive effect on the postoperative rehabilitation of patients. The reason for this is that surgical trauma can cause local inflammation and, in some cases, systemic inflammation. The intestinal mucosa has greater blood flow and gradually secretes increasing amounts of pepsin, which leads to the inability of the intestinal tract to continue to move according to its original state. A certain amount of pain-causing substances appear, increasing the incidence of complications[18,19]. Endogenous opioids can be formed under the influence of acupuncture, thus fundamentally controlling the appearance of endogenous pain-causing substances to prevent patients from experiencing complications such as pain, abdominal distension and pain, incision infection, anastomotic leakage, and adhesive intestinal obstruction and others[20].

CONCLUSION

In summary, the importance of acupuncture therapy is prominent in patients undergoing low-tension rectal cancer surgery. It is an important therapy for improving the serum levels in patients, relieving the symptoms of anal incontinence, reducing the possibility of complications, and helping patients achieve good postoperative rehabilitation. It has significant promotional and application value.