Predictive Factors for Bowel Dysfunction after Sphincter-Preserving Surgery for Rectal Cancer: A Single-Center Cross-sectional Study

BACKGROUND: With increasing rates of sphincter preservation because of advances in preoperative chemoradiation, restoration of bowel continuity has become a main goal of rectal cancer treatment. However, in many patients, postoperative bowel dysfunction negatively affects the quality of life. OBJECTIVE: This study aimed to analyze predictors of bowel dysfunction after sphincter-preserving surgery in patients with rectal cancer. DESIGN: This was a cross-sectional study. SETTINGS: Assessment of bowel dysfunction was conducted between November 2015 and June 2017 at our institution. PATIENTS: A total of 316 patients with rectal cancer who underwent sphincter-preserving surgery between February 2009 and April 2017 and agreed with an interview for assessing bowel dysfunction were included. MAIN OUTCOME MEASURES: Bowel dysfunction was assessed with the Memorial Sloan Kettering Cancer Center Bowel Function Instrument and Wexner score. All the assessments were conducted face-to-face by the same interviewer. RESULTS: The median time interval between the restoration of bowel continuity and assessment was 10 months (interquartile range, 3-37), and the median total Memorial Sloan Kettering Cancer Center and Wexner scores were 65 (interquartile range, 58-73) and 6 (interquartile range, 0-11). The time interval was correlated with the Memorial Sloan Kettering Cancer Center scores (rho, 0.279) and Wexner scores (rho, -0.306). In a multivariate analysis, handsewn anastomosis and short time interval (≤1 year) were independently associated with poor bowel function (Memorial Sloan Kettering Cancer Center score ≤65). A short time interval (≤1 year), preoperative chemoradiation, and ileostomy were independently associated with major fecal incontinence (Wexner ≥8). LIMITATIONS: Selection bias may be inherent. CONCLUSIONS: Bowel function recovers with time after the restoration of bowel continuity. A short time interval, handsewn anastomosis, preoperative chemoradiation, and ileostomy were significantly associated with poor bowel function or major fecal incontinence. Surgeons should discuss postoperative bowel dysfunction and its predictive factors with the patients. See Video Abstract at http://links.lww.com/DCR/A930.