Sanne J Verkuijl1, Christiaan Hoff2, Edgar J B Furnee3, Wendy Kelder4, Daniel A Hess5, Fennie Wit6, Ronald J Zijlstra7, Monika Trzpis1, Paul M A Broens1,8. 1. Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. 2. Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, the Netherlands. 3. Department of Surgery, Division of Abdominal Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. 4. Department of Surgery, Martini Hospital, Groningen, the Netherlands. 5. Department of Surgery, Antonius Hospital, Sneek, the Netherlands. 6. Department of Surgery, Tjongerschans Hospital, Heerenveen, the Netherlands. 7. Department of Surgery, Nij Smellinghe Hospital, Drachten, the Netherlands. 8. Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Abstract
BACKGROUND: The exact relation between anastomotic height after rectal cancer surgery and postoperative bowel function problems has not been investigated in the long term, causing ineffective treatment. OBJECTIVE: To determine the effect of anastomotic height on long-term bowel function and generic quality of life. DESIGN: A multicenter cross-sectional study. SETTINGS: Seven Dutch hospitals in the north of the Netherlands participated. PATIENTS: All patients who underwent rectal cancer surgery between 2009 and 2015 in the participating hospitals received the validated Defecation and Fecal Continence and Short-Form 36 questionnaires. Deceased patients, patients with a permanent stoma or an anastomosis >15 cm from the anal verge, intellectual disability, or living abroad were excluded. MAIN OUTCOME MEASURES: Primary outcomes were constipation (Rome IV), fecal incontinence (Rome IV), and major low anterior resection syndrome. Secondary outcomes were the generic quality of life scores. RESULTS: The study population (N=630) had a median follow-up of 58.0 months. In multivariable analysis, constipation (OR = 1.08, 95% CI, 1.02-1.15, p = 0.011), fecal incontinence (OR = 0.91, 95% CI, 0.84-0.97, p = 0.006), and major low anterior resection syndrome (OR = 0.93, 95% CI, 0.87-0.99, p = 0.027), were significantly associated with anastomotic height. The curves illustrating the probability of constipation and fecal incontinence crossed at an anastomotic height of 7 cm, with 95% CIs overlapping between 4.5-9.5 cm. There was no relation between quality of life scores and anastomotic height. LIMITATIONS: The study is limited by its cross-sectional design. CONCLUSIONS: This study might serve as a guide for the clinician to effectively screen and treat fecal incontinence and constipation during the follow-up of patients after rectal cancer surgery. More attention should be paid to fecal incontinence in patients with an anastomosis below 4.5 cm and towards constipation in patients with an anastomosis above 9.5 cm. See Video Abstract at http://links.lww.com/DCR/B858. (C) 2022 The American Society of Colon and Rectal Surgeons.
BACKGROUND: The exact relation between anastomotic height after rectal cancer surgery and postoperative bowel function problems has not been investigated in the long term, causing ineffective treatment. OBJECTIVE: To determine the effect of anastomotic height on long-term bowel function and generic quality of life. DESIGN: A multicenter cross-sectional study. SETTINGS: Seven Dutch hospitals in the north of the Netherlands participated. PATIENTS: All patients who underwent rectal cancer surgery between 2009 and 2015 in the participating hospitals received the validated Defecation and Fecal Continence and Short-Form 36 questionnaires. Deceased patients, patients with a permanent stoma or an anastomosis >15 cm from the anal verge, intellectual disability, or living abroad were excluded. MAIN OUTCOME MEASURES: Primary outcomes were constipation (Rome IV), fecal incontinence (Rome IV), and major low anterior resection syndrome. Secondary outcomes were the generic quality of life scores. RESULTS: The study population (N=630) had a median follow-up of 58.0 months. In multivariable analysis, constipation (OR = 1.08, 95% CI, 1.02-1.15, p = 0.011), fecal incontinence (OR = 0.91, 95% CI, 0.84-0.97, p = 0.006), and major low anterior resection syndrome (OR = 0.93, 95% CI, 0.87-0.99, p = 0.027), were significantly associated with anastomotic height. The curves illustrating the probability of constipation and fecal incontinence crossed at an anastomotic height of 7 cm, with 95% CIs overlapping between 4.5-9.5 cm. There was no relation between quality of life scores and anastomotic height. LIMITATIONS: The study is limited by its cross-sectional design. CONCLUSIONS: This study might serve as a guide for the clinician to effectively screen and treat fecal incontinence and constipation during the follow-up of patients after rectal cancer surgery. More attention should be paid to fecal incontinence in patients with an anastomosis below 4.5 cm and towards constipation in patients with an anastomosis above 9.5 cm. See Video Abstract at http://links.lww.com/DCR/B858. (C) 2022 The American Society of Colon and Rectal Surgeons.