Abstract
AimOur aim was to assess bowel function and its effect on overall quality of life (QOL) when compared to healthy controls after colectomy.MethodsPatients undergoing resection of colorectal neoplasia were recruited pre-operatively and followed up at 6 and 12 months, to assess ‘early’ bowel function. Patients who underwent surgery 2 to 4 years previously were recruited for assessment of ‘intermediate’ bowel function. Healthy relatives were recruited as controls. The Memorial Sloan-Kettering Cancer Centre and EQ-5D questionnaires were used to assess bowel function and QOL, respectively. Statistical assessment included regression analyses, parametric and non-parametric tests. The association between QOL and Memorial Sloan-Kettering Cancer Centre (MSKCC) scores was evaluated using Spearman’s rank correlation.ResultsNinety-one patients were recruited for assessment of ‘early’ and 85 for ‘intermediate’ bowel function. There were 85 controls. Patients had a significantly higher number of bowel movements at each follow-up (p < 0.001). At 12 months after surgery, patients reported difficulty with gas-stool discrimination. The ‘intermediate’ group were found to have lower scores for flatus control (<0.001) and total frequency score (p 0.03), indicating worse function. Patients with higher total MSKCC scores, no symptoms of urgency and those able to control flatus reported better QOL (p 0.006, 0.007 and 0.005, respectively) at 6 and 12 months. Gas-stool differentiation and complete evacuation correlated with better QOL in the ‘intermediate’ bowel function group (p 0.02 and 0.02, respectively).ConclusionColonic resection adversely affects elements of bowel function up to 4 years after surgery. Good colonic function, represented by higher MSKCC scores, correlates with better QOL.
Highlights
Most healthy individuals average one bowel movement per day [1]
Ninety-one patients were recruited for assessment of ‘early’ and 85 for ‘intermediate’ bowel function
Int J Colorectal Dis (2017) 32:777–787 function and quality of life (QOL) after colonic resection is scarcely reported in the literature
Summary
Most healthy individuals average one bowel movement per day [1]. Colorectal physiology involves absorption of water and electrolytes, coordinated propulsion of faecal mass from the right colon to the rectum, storage and expulsion [2]. Validated questionnaires to assess bowel function and related QOL were not utilised in these studies. Bowel function is usually reported as numeric data from self-constructed questionnaire surveys [6,7,8,9]. This makes it challenging to translate the scanty data that are available into clinically meaningful information for patients. To address the gap in our knowledge, we designed a prospective study to assess ‘early’ (≤12 months after surgery) and ‘intermediate’ (2 to 4 years after surgery) bowel function in patients undergoing hemicolectomy with en bloc mesenteric resection (open and laparoscopic). Our proposed hypothesis was that potentially curative hemicolectomy for colonic neoplasia (benign or malignant) adversely affects bowel function and QOL
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