Fecal incontinence after total mesorectal excision for rectal cancer\u2014impact of potential risk factors and pelvic intraoperative neuromonitoring

Daniel W Kauff,Rika S Bettzieche,Werner Kneist,Yvonne D S Roth

doi:10.1186/s12957-020-1782-6

Abstract

BackgroundFecal incontinence frequently occurs after total mesorectal excision for rectal cancer. This prospective study analyzed predictive factors and the impact of pelvic intraoperative neuromonitoring at different follow-up intervals.MethodsFifty-two patients were included undergoing total mesorectal excision for rectal cancer, and 29 under control of pelvic intraoperative neuromonitoring. Fecal incontinence was assessed using the Wexner Score at 3 and 6 months after stoma closure (follow-ups 1 and 2) as well as 1 and 2 years after surgery (follow-ups 3 and 4). Risk factors were identified by means of logistic regression.ResultsNew onset of fecal incontinence was significantly lower in the neuromonitoring group at each follow-up (follow-up 1: 2 of 29 patients (7%) vs. 8 of 23 (35%), (p = 0.014); follow-up 2: 3 of 29 (10%) vs. 9 of 23 (39%), (p = 0.017); follow-up 3: 5 of 29 (17%) vs. 11 of 23 (48%), p = 0.019; follow-up 4: 6 of 28 (21%) vs. 11 of 22 (50%), p = 0.035).Non-performance of neuromonitoring was found to be an independent predictor for fecal incontinence throughout the survey. Neoadjuvant chemoradiotherapy was an independent predictor in the further course 1 and 2 years after surgery.ConclusionsPerformance of pelvic intraoperative neuromonitoring is associated with significantly lower rates of fecal incontinence. Neoadjuvant chemoradiotherapy was found to have negative late effects. This became evident 1 year after surgery.

Highlights

Fecal incontinence frequently occurs after total mesorectal excision for rectal cancer
The present study demonstrated that up to one third of the patients undergoing total mesorectal excision (TME) for rectal cancer suffer from fecal incontinence (FI) with a diminished quality of life even 2 years after surgery
The striking finding of the present study is that performing pelvic intraoperative neuromontoring (pIONM) reduces the incidence of FI in the short course, and in the further course 2 years after TME

Summary

Introduction

Fecal incontinence frequently occurs after total mesorectal excision for rectal cancer This prospective study analyzed predictive factors and the impact of pelvic intraoperative neuromonitoring at different follow-up intervals. Bowel dysfunction after total mesorectal excision (TME) for rectal cancer occurs frequently. It seriously impacts patients’ daily lives leading to physical and to emotional suffering with persistent feelings of insecurity. Anorectal dysfunction includes fecal incontinence (FI), Several instruments were used for evaluation of postoperative bowel dysfunction. This resulted in substantial variations in the reporting of the abovementioned symptoms. The most frequently used instrument is the validated Wexner Score focusing on FI [4]

Methods

Results

Discussion

Conclusion