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Risk factors for bowel dysfunction after sphincter-preserving rectal cancer surgery

A prospective study in the Diseases of the Colon & Rectum uses the Memorial Sloan Kettering Cancer Center Bowel Function Instrument to identify risk factors for bowel dysfunction after sphincter-preserving rectal cancer surgery.

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Until recently, no studies have prospectively evaluated bowel function after sphincter-preserving surgery for rectal cancer with the use of a validated bowel function scoring system.

Dr Myong Hoon Ihn and colleagues investigated possible risk factors for altered bowel function after sphincter-preserving surgery.

The team performed a prospective study conducted between 2006 and 2012.

Patients who underwent sphincter-preserving rectal cancer surgery were recruited.

The research team assessed bowel function 1 day before, and at 1 year after sphincter-preserving surgery or temporary ileostomy takedown with the use of the Memorial Sloan Kettering Cancer Center questionnaire.
 
Multivariable analysis was performed to identify the factors associated with altered bowel function after surgery.

Tumor was located in the upper rectum in 26%
Diseases of the Colon & Rectum

Overall, 266 patients were eligible for the analysis.

The researchers found that the tumor was located in the upper, middle, and lower rectum in 26%, 43%, and 32% of patients.

Intersphincteric resection and temporary ileostomy were performed in 7%, and 49% of patients.

The team found that the mean Memorial Sloan Kettering Cancer Center score was 65 at 1 year after sphincter-preserving surgery or temporary ileostomy takedown.

The Memorial Sloan Kettering Cancer Center score decreased in 61% of patients between baseline and 1 year after surgery.

The team noted that tumor location, operative method, anastomotic type, and temporary ileostomy were associated with altered bowel function after sphincter-preserving surgery in univariate analyses.

The researchers observed that only tumor location was independently associated with impaired bowel function after sphincter-preserving rectal cancer surgery.

Dr Ihn's team concludes, "We suggest that preoperative counseling should be implemented to inform patients of the risk of bowel dysfunction, especially in patients with lower rectal cancer, although this study cannot exclude the effect of chemoradiotherapy owing to the limitation of study."

Dis Colon Rectum 2014: 57(8): 958–966
05 August 2014

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