The University of Southampton
University of Southampton Institutional Repository
Warning ePrints Soton is experiencing an issue with some file downloads not being available. We are working hard to fix this. Please bear with us.

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
Sequential assessment of bowel function and anorectal physiology after anterior resection for cancer: a prospective cohort study

Aim: to investigate changes in bowel function and anorectal physiology (ARP) after anterior resection for colorectal cancer.

Methods: patients were recruited from November 2006 to September 2008. Cleveland Clinic Incontinence (CCI) scores and stool frequency were determined by patient questionnaires before surgery (t0 ) and at three (t3 ), six (t6 ), nine (t9 ) and 12 (t12 ) months after restoration of intestinal continuity. ARP measurements were recorded at t0 , t3 and t12 . Endoanal ultrasound was performed at t0 and t12 .

Results: eighty-nine patients were included in the study. CCI score increased post-operatively then normalised, whereas stool frequency did not change. Patients who had neoadjuvant radiotherapy or lower anastomoses had increased incontinence and stool frequency in the post-operative 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 post-operative period. Radiotherapy, lower anastomosis and defunctioning stoma (but not operative approach) altered manometric parameters post-operatively. Maximum tolerance correlated with incontinence and first urge with stool frequency. Anterior internal anal sphincter thickness decreased post-operatively.

Conclusions: incontinence recovers in the first year after anterior resection. Radiotherapy, lower anastomosis, defunctioning stoma and open surgery negatively influence bowel function. ARP may be useful if bowel dysfunction persists beyond 12 months.

anorectal physiology, anterior resection, colorectal cancer, incontinence, stool frequency
1462-8910
2436-2446
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
2a78dfbb-ee78-4f83-baa6-a0016a2d75d6
Dudding, T C
48b98a0a-39ee-4847-b599-46b8e626d900
Knight, J S
43d732fc-8e92-4698-87ea-94248b7e6195
King, A T
4b9a9fda-db61-4a5f-9258-1997446a8bd5
Mirnezami, A H
b3c7aee7-46a4-404c-bfe3-f72388e0bc94
Beck, N E
596183d1-9caa-47a5-92e4-b0e7057c880f
Nichols, P H
c3b67bd0-22c2-41a5-839a-e4091c1bcf8c
Nugent, K P
79fcb89d-6ff2-47b8-ac2c-2afb24954456
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
2a78dfbb-ee78-4f83-baa6-a0016a2d75d6
Dudding, T C
48b98a0a-39ee-4847-b599-46b8e626d900
Knight, J S
43d732fc-8e92-4698-87ea-94248b7e6195
King, A T
4b9a9fda-db61-4a5f-9258-1997446a8bd5
Mirnezami, A H
b3c7aee7-46a4-404c-bfe3-f72388e0bc94
Beck, N E
596183d1-9caa-47a5-92e4-b0e7057c880f
Nichols, P H
c3b67bd0-22c2-41a5-839a-e4091c1bcf8c
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), 2436-2446. (doi:10.1111/codi.15754).

Record type: Article

Abstract

Aim: to investigate changes in bowel function and anorectal physiology (ARP) after anterior resection for colorectal cancer.

Methods: patients were recruited from November 2006 to September 2008. Cleveland Clinic Incontinence (CCI) scores and stool frequency were determined by patient questionnaires before surgery (t0 ) and at three (t3 ), six (t6 ), nine (t9 ) and 12 (t12 ) months after restoration of intestinal continuity. ARP measurements were recorded at t0 , t3 and t12 . Endoanal ultrasound was performed at t0 and t12 .

Results: eighty-nine patients were included in the study. CCI score increased post-operatively then normalised, whereas stool frequency did not change. Patients who had neoadjuvant radiotherapy or lower anastomoses had increased incontinence and stool frequency in the post-operative 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 post-operative period. Radiotherapy, lower anastomosis and defunctioning stoma (but not operative approach) altered manometric parameters post-operatively. Maximum tolerance correlated with incontinence and first urge with stool frequency. Anterior internal anal sphincter thickness decreased post-operatively.

Conclusions: incontinence recovers in the first year after anterior resection. Radiotherapy, lower anastomosis, defunctioning stoma and open surgery negatively influence bowel function. ARP may be useful if bowel dysfunction persists beyond 12 months.

Text
codi.15754 - Accepted Manuscript
Available under License Creative Commons Attribution.
Download (12MB)

More information

Accepted/In Press date: 25 May 2021
e-pub ahead of print date: 25 May 2021
Additional Information: ACKNOWLEDGEMENTS RB is an NIHR funded Clinical Lecturer.
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

Catalogue record

Date deposited: 11 Jun 2021 16:30
Last modified: 09 Jan 2022 01:54

Export record

Altmetrics

Contributors

Author: S A Pilkington
Author: Rahul Bhome
Author: Sally Gilbert
Author: S Harris
Author: Carl Richardson
Author: T C Dudding
Author: J S Knight
Author: A T King
Author: A H Mirnezami
Author: N E Beck
Author: P H Nichols
Author: K P Nugent

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×