Functional Assessment After Local Excision of Rectal Tumors

Abstract

In Brief Purpose: The aim of this study was to identify the functional consequences of local excision for rectal tumors. Methods: We examined all patients who underwent full-thickness local excision of various rectal masses over a 10-year period at our institution. The patient cohort was subdivided into 2 groups. Group 1 consisted of patients who underwent local excision alone, whereas group 2 had local excision with postoperative chemotherapy and radiation. Each patient was surveyed to compare preoperative and postoperative changes in various aspects of defecatory function using each patient as his or her own control. Results: Fifty patients were contacted and interviewed. Of the 50, 45 had undergone local excision alone and 5 required adjuvant therapy. Group 1 noticed no specific changes in bowel function and had no change in the number of bowel movements per day postoperatively compared with their preoperative status. Almost all patients in group 2 who underwent adjuvant treatment noticed a decrement change in their function. This group had a mean of 3.8 bowel movements per day postoperatively as compared with 1.9 before surgery. Group 2 also noticed an increase in frequency of clustered bowel movements from no occurrences to 2 to 3 per week posttreatment and experienced a definite decreased ability to delay defecation when faced with urgency. Preoperatively, group 2 could delay defecation for 30 minutes or greater, whereas postoperatively this time fell to 15 minutes. Group 1 had no significant change in the ability to defer defecation postoperatively. Lastly, each group was questioned about incontinence of flatus and liquid or solid stool. Neither group demonstrated incontinence after their respective treatments. Conclusion: Patients who undergo local excision for rectal cancer can expect to have no change in their defecatory function after surgery. However, patients who also require treatment with chemotherapy and radiation therapy will likely have moderate impairment of their function. Local excision of rectal tumors combined with chemoradiotherapy causes detrimental effects on fecal continence.