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Evaluation of Long-term Anorectal Function After Low Anterior Resection: A 5-Year Follow-up of a Randomized Multicenter Trial
Örebro University Hospital. Dept Surg.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Surg.
Linköping Univ Hosp, Dept Surg, Linköping, Sweden.
Örebro University Hospital. Dept Surg.
2014 (English)In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 57, no 10, 1162-1168 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Anorectal function after rectal surgery with low anastomosis is often impaired. Outcome of long-term anorectal function is poorly understood but may improve over time.

OBJECTIVE: We evaluated anorectal function 5 years after low anterior resection for cancer with regard to whether patients had a temporary stoma at initial resection. The objective of this study was to assess changes in anorectal function over time by comparing the results with anorectal function 1 year after rectal resection.

DESIGN: This study was a secondary end point of a randomized, multicenter controlled trial.

SETTINGS: The study was conducted at 21 Swedish hospitals performing rectal cancer surgery from 1999 to 2005.

PATIENTS: Patients included were those operated on with low anterior resection.

INTERVENTIONS: Patients were randomly assigned to receive or not receive a defunctioning stoma.

MAIN OUTCOME MEASURES: We evaluated anorectal function in patients who were initially randomly assigned to the defunctioning stoma or no stoma group, who had been free of stoma for 5 years, by means of using a standardized patient questionnaire. Questions addressed stool frequency, urgency, fragmentation of bowel movements, evacuation difficulties, incontinence, lifestyle alterations, and patient preference regarding permanent stoma formation. Results were compared with the same patient cohort at 1-year follow-up.

RESULTS: A total of 123 patients answered the bowel function questionnaire (65 in the no-stoma group and 58 in the stoma group). No differences were found between groups regarding the number of passed stools, need for medication to open the bowel, evacuation difficulties, incontinence, and urgency. General well-being was significantly better in the no-stoma group (p = 0.033). Comparison with anorectal function at 1 year showed no further changes over time.

LIMITATIONS: The study was based on a limited sample size (n = 123) and formed a secondary end point of a randomized trial.

CONCLUSIONS: Anorectal function was impaired for many patients, but the temporary presence of a defunctioning stoma after rectal resection did not affect long-term outcome. Anorectal function did not change between 1-year and 5-year follow-up.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2014. Vol. 57, no 10, 1162-1168 p.
Keyword [en]
Anorectal function, Defunctioning stoma, Long-term follow-up, Rectal cancer
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-37865DOI: 10.1097/DCR.0000000000000197ISI: 000341970500002PubMedID: 25203371Scopus ID: 2-s2.0-84908303580OAI: oai:DiVA.org:oru-37865DiVA: diva2:757475
Note

Funding Agency:

Örebro County Council (Örebro, Sweden)

Available from: 2014-10-22 Created: 2014-10-20 Last updated: 2017-10-18Bibliographically approved
In thesis
1. Defunctioning stoma in low anterior resection of the rectum for cancer: Aspects of stoma reversal, anastomotic leakage, anorectal function, and cost-effectiveness
Open this publication in new window or tab >>Defunctioning stoma in low anterior resection of the rectum for cancer: Aspects of stoma reversal, anastomotic leakage, anorectal function, and cost-effectiveness
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Rectal cancer is a common malignancy treated with surgical resection and curative intent in the majority of cases. One treatment option is low anterior resection (LAR) with preserved bowel continuity, often involving the formation of a temporary defunctioning stoma (DS).

The general aim of this thesis was to improve understanding of the role of DS in rectal cancer surgery with regard to timing of stoma reversal and development of anastomotic leakage (AL), impact on long-term anorectal function (AF), as well as aspects of cost-effectiveness.

Study I addressed the timing of stoma reversal following LAR. We found that 19% of reversed patients were reversed within 4 months of LAR, while 81% of reversals were delayed. In 58% of delayed reversals the delay was due to low priority on surgical waiting lists.

Studies II-IV were based on 234 patients randomized to receive a DS or no DS following LAR. Study II compared patients with AL following LAR diagnosed during the initial hospital stay (early leakage, EL) with patients diagnosed after hospital discharge (late leakage, LL). LL was more common in females, and originated more frequently from the transverse stapler line. EL was more common in males, and originated more frequently from the circular stapler line. Study III assessed AF 5 years after LAR with regard to whether patients initially had a DS or no DS. We found no difference in AF between the two randomized groups. When comparing with a 1-year follow-up in the same patient cohort, there were no further changes in AF over time. Study III assessed necessary healthcare resources and cost within 5 years of LAR, depending on whether patients initially had a DS or no DS. The overall cost analysis revealed a higher cost for patients randomized to DS, regardless of the cost-savings associated with a reduced frequency of anastomotic leakage.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. 56 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 143
Keyword
rectal cancer, low anterior resection, defunctioning stoma, stoma reversal, anastomotic leakage, anorectal function, costs, resources
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-49021 (URN)978-91-7529-139-0 (ISBN)
Public defence
2016-05-27, Universitetssjukhuset, Bomanssonsalen, Södra Grev Rosengatan, Örebro, 09:15 (English)
Opponent
Supervisors
Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2017-10-17Bibliographically approved

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