Patient‐reported and physician‐recorded bowel dysfunction following colorectal resection and radical cystectomy: a prospective, comparative study

Aim Bowel dysfunction following anterior resection (AR) is termed low anterior resection syndrome. It is unclear whether such dysfunction occurs following other bowel/pelvic operations as well. This study aimed to characterize and compare bowel dysfunction following AR, right hemicolectomy (RH) and radical cystectomy (RC). Method A prospective study of consecutive patients undergoing AR, RH and RC (2002–2012) was performed at a tertiary referral centre in Sydney, Australia. Outcome measures included (i) patient‐reported satisfaction with bowel function, self‐described bowel function and self‐reported change in bowel function; (ii) objective assessment of bowel function using validated criteria to identify symptoms and stratify patients into those with constipation and/or faecal incontinence (FI); and (iii) health‐related quality of life (SF‐36v2 Health Survey). Results Of 743 eligible patients, 70% participated [AR, n  = 338, mean age 69.6 years (SD 11.9), 59% men; RH, n  = 150, 75.8 years (SD 10.5), 54% men; RC, n  = 34, 71.1 years (SD 14.1), 71% men]. AR patients were three times more likely to report change in bowel function post‐surgery and self‐judged their bowel function as abnormal more frequently (64%) than RH patients (35%) and RC patients (35%) ( P  < 0.01). AR patients were four times more likely to meet criteria for concomitant constipation and FI. Patients with concomitant constipation and FI had lower physical and mental SF‐36v2 scores ( P  < 0.001). Conclusion Bowel dysfunction occurred after RH and RC but rates were higher following AR. This suggests that low anterior resection syndrome occurs due to a direct impact of partial/complete loss of the rectum rather than just due to loss of bowel length and/or the consequence(s) of pelvic dissection.