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

Abstract

BackgroundThe purpose of this study was to describe postoperative bowel dysfunction after restorative proctectomy, and to identify factors associated with its development. MethodsPatients 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. ResultsIn 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). ConclusionBowel dysfunction was common after restorative proctectomy, and several patient, disease, and treatment-level factors were associated with its development.