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Sequential assessment of bowel function and anorectal physiology after anterior resection for cancer: a prospective cohort study
Author(s) -
Pilkington Sophie A.,
Bhome Rahul,
Gilbert Sally,
Harris Scott,
Richardson Carl,
Dudding Thomas C.,
Knight John S.,
King Andrew T.,
Mirnezami Alex H.,
Beck Nicholas E.,
Nichols Paul H.,
Nugent Karen P.
Publication year - 2021
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.15754
Subject(s) - medicine , anastomosis , stoma (medicine) , colorectal cancer , internal anal sphincter , endoanal ultrasound , colorectal surgery , radiation therapy , anorectal manometry , surgery , fecal incontinence , defecation , prospective cohort study , sphincter , coloanal anastomosis , abdominal surgery , rectum , anal canal , cancer
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.