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Assessment of long-term bowel dysfunction after restorative proctectomy for neoplastic disease: A population-based cohort study

Published:November 27, 2021DOI:https://doi.org/10.1016/j.surg.2021.10.068

      Abstract

      Background

      The purpose of this study was to describe postoperative bowel dysfunction after restorative proctectomy, and to identify factors associated with its development.

      Methods

      Patients who underwent restorative proctectomy for rectal cancer between April 1998 and November 2018 were identified from the Hospital Episode Statistics database and linked to the Clinical Practice Research Datalink for postoperative follow-up. Bowel dysfunction was defined according to relevant symptom-based read codes and medication prescription–product codes. A Cox proportional hazards model was performed to identify factors associated with postoperative bowel dysfunction, adjusting for relevant covariates.

      Results

      In total, 2,197 patients were included. The median age was 70.0 (interquartile range: 62.0–77.0) years old, and the majority (59.2%) of patients were male. After a median follow-up of 51.6 (24.0–90.0) months, bowel dysfunction was identified in 620 (28.2%) patients. Risk factors for postoperative bowel dysfunction included extremes of age (<40 years old: adjusted hazards ratio 2.35, 95% confidence interval 1.18–4.65; 70–79 years old: adjusted hazards ratio 1.25, 95% confidence interval 1.03–1.52), radiotherapy (adjusted hazards ratio 1.94, 95% confidence interval 1.56–2.42), distal tumors (adjusted hazards ratio 1.62, 95% confidence interval 1.34–1.94), history of diverting ostomy (adjusted hazards ratio 1.58, 95% confidence interval 1.33–1.89), and anastomotic leak (adjusted hazards ratio 1.48, 95% confidence interval 1.06–2.05). A minimally invasive surgical approach was protective for postoperative bowel dysfunction (adjusted hazards ratio 0.68, 95% confidence interval 0.53–0.86).

      Conclusion

      Bowel dysfunction was common after restorative proctectomy, and several patient, disease, and treatment-level factors were associated with its development.
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      Linked Article

      • Big data exposes the tip of the LARS iceberg
        SurgeryVol. 172Issue 3
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          Multidisciplinary treatment algorithms for rectal cancer are often complex and may take many months to complete. Total neoadjuvant treatment for locally advanced rectal cancer, for example, typically includes systemic induction chemotherapy followed by short-course radiotherapy or long-course chemotherapy, and then surgical resection several weeks later. With a subsequent postoperative recovery, the patient may spend the better part of a year in treatment. If a temporary diverting stoma is required, there may be a further delay to restoration of bowel continuity.
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