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

Autor: Pilkington SA; Colorectal Unit, University Hospitals Southampton NHS Trust, Southampton, UK., Bhome R; Colorectal Unit, University Hospitals Southampton NHS Trust, Southampton, UK.; University Surgery, Southampton General Hospital, University of Southampton, Southampton, UK.; Cancer Sciences, Southampton General Hospital, University of Southampton, Southampton, UK., Gilbert S; Colorectal Unit, University Hospitals Southampton NHS Trust, Southampton, UK., Harris S; Primary Care and Population Studies, Southampton General Hospital, University of Southampton, Southampton, UK., Richardson C; Colorectal Unit, University Hospitals Southampton NHS Trust, Southampton, UK., Dudding TC; Colorectal Unit, University Hospitals Southampton NHS Trust, Southampton, UK., Knight JS; Colorectal Unit, University Hospitals Southampton NHS Trust, Southampton, UK., King AT; Colorectal Unit, University Hospitals Southampton NHS Trust, Southampton, UK., Mirnezami AH; Colorectal Unit, University Hospitals Southampton NHS Trust, Southampton, UK.; University Surgery, Southampton General Hospital, University of Southampton, Southampton, UK.; Cancer Sciences, Southampton General Hospital, University of Southampton, Southampton, UK., Beck NE; Colorectal Unit, University Hospitals Southampton NHS Trust, Southampton, UK., Nichols PH; Colorectal Unit, University Hospitals Southampton NHS Trust, Southampton, UK., Nugent KP; Colorectal Unit, University Hospitals Southampton NHS Trust, Southampton, UK.; University Surgery, Southampton General Hospital, University of Southampton, Southampton, UK.
Jazyk: angličtina
Zdroj: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2021 Sep; Vol. 23 (9), pp. 2436-2446. Date of Electronic Publication: 2021 Jun 23.
DOI: 10.1111/codi.15754
Abstrakt: 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.
(© 2021 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.)
Databáze: MEDLINE
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