Sequential assessment of bowel function and anorectal physiology after anterior resection for cancer: a prospective cohort study
Sequential assessment of bowel function and anorectal physiology after anterior resection for cancer: a prospective cohort study
Aim: The aim of this study was to investigate changes in bowel function and anorectal physiology (ARP) after anterior resection for colorectal cancer. Method: Patients were recruited from November 2006 to September 2008. Cleveland Clinic Incontinence (CCI) scores and stool frequency were determined by patient questionnaires before surgery (t
0) and at three (t
3), six (t
6), nine (t
9) and 12 (t
12) months after restoration of intestinal continuity. ARP measurements were recorded at T
0, T
3 and T
12. Endoanal ultrasound was performed at T
0 and T
12. Results: Eighty-nine patients were included. CCI score increased postoperatively then normalized, whereas stool frequency did not change. Patients who had neoadjuvant radiotherapy or a lower anastomosis had increased incontinence and stool frequency in the postoperative period, whereas those with defunctioning stomas or open surgery had increased stool frequency alone. Maximum resting pressure, volume at first urge and maximum rectal tolerance were reduced throughout the postoperative period. Radiotherapy, lower anastomosis and defunctioning stoma (but not operative approach) altered manometric parameters postoperatively. Maximum rectal tolerance correlated with incontinence and first urge with stool frequency. The length of the anterior internal anal sphincter decreased postoperatively. Conclusions: Incontinence recovers in the first year after anterior resection. Radiotherapy, lower anastomosis, defunctioning stoma and open surgery have a negative influence on bowel function. ARP may be useful if bowel dysfunction persists beyond 12 months.
anorectal physiology, anterior resection, colorectal cancer, incontinence, stool frequency
2436-2446
Pilkington, S A
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Bhome, Rahul
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Gilbert, Sally
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Harris, S
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Richardson, Carl
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Dudding, T C
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Knight, J S
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King, A T
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Mirnezami, A H
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Beck, N E
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Nichols, P H
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Nugent, K P
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September 2021
Pilkington, S A
eeea48ff-2596-4502-8414-1cc8f9940643
Bhome, Rahul
d7b1e0d3-5925-460a-871d-5f52f69c649b
Gilbert, Sally
dffa397f-5bca-44b4-9167-72e8d75b1a49
Harris, S
19ea097b-df15-4f0f-be19-8ac42c190028
Richardson, Carl
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Dudding, T C
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Knight, J S
43d732fc-8e92-4698-87ea-94248b7e6195
King, A T
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Mirnezami, A H
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Beck, N E
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Nichols, P H
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Nugent, K P
79fcb89d-6ff2-47b8-ac2c-2afb24954456
Pilkington, S A, Bhome, Rahul, Gilbert, Sally, Harris, S, Richardson, Carl, Dudding, T C, Knight, J S, King, A T, Mirnezami, A H, Beck, N E, Nichols, P H and Nugent, K P
(2021)
Sequential assessment of bowel function and anorectal physiology after anterior resection for cancer: a prospective cohort study.
Colorectal Disease, 23 (9), .
(doi:10.1111/codi.15754).
Abstract
Aim: The aim of this study was to investigate changes in bowel function and anorectal physiology (ARP) after anterior resection for colorectal cancer. Method: Patients were recruited from November 2006 to September 2008. Cleveland Clinic Incontinence (CCI) scores and stool frequency were determined by patient questionnaires before surgery (t
0) and at three (t
3), six (t
6), nine (t
9) and 12 (t
12) months after restoration of intestinal continuity. ARP measurements were recorded at T
0, T
3 and T
12. Endoanal ultrasound was performed at T
0 and T
12. Results: Eighty-nine patients were included. CCI score increased postoperatively then normalized, whereas stool frequency did not change. Patients who had neoadjuvant radiotherapy or a lower anastomosis had increased incontinence and stool frequency in the postoperative period, whereas those with defunctioning stomas or open surgery had increased stool frequency alone. Maximum resting pressure, volume at first urge and maximum rectal tolerance were reduced throughout the postoperative period. Radiotherapy, lower anastomosis and defunctioning stoma (but not operative approach) altered manometric parameters postoperatively. Maximum rectal tolerance correlated with incontinence and first urge with stool frequency. The length of the anterior internal anal sphincter decreased postoperatively. Conclusions: Incontinence recovers in the first year after anterior resection. Radiotherapy, lower anastomosis, defunctioning stoma and open surgery have a negative influence on bowel function. ARP may be useful if bowel dysfunction persists beyond 12 months.
Text
codi.15754
- Accepted Manuscript
More information
Accepted/In Press date: 25 May 2021
e-pub ahead of print date: 25 May 2021
Published date: September 2021
Additional Information:
Funding Information:
RB is an NIHR funded Clinical Lecturer.
Publisher Copyright:
© 2021 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland
Keywords:
anorectal physiology, anterior resection, colorectal cancer, incontinence, stool frequency
Identifiers
Local EPrints ID: 449696
URI: http://eprints.soton.ac.uk/id/eprint/449696
ISSN: 1462-8910
PURE UUID: 0c04d734-353f-430f-8913-f54b731c2b6c
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Date deposited: 11 Jun 2021 16:30
Last modified: 17 Mar 2024 03:31
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Contributors
Author:
S A Pilkington
Author:
Sally Gilbert
Author:
Carl Richardson
Author:
T C Dudding
Author:
J S Knight
Author:
A T King
Author:
N E Beck
Author:
P H Nichols
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