Bowel dysfunction after treatment for rectal cancer

Figures & data

Table I.  Functional outcome after 12 months after LAR.

	Williamson et al. [5] N = 19	Machado et al. [12]† N = 43	Rasmussen et al. [13] N = 43	Ho et al. [14]* N = 87
Urgency	6%	53%		34.9%
Bowel frequency Defaecations/day Medium (range)	4 (1–7)	3.0 (2–4.9)	3 (1–10)	2.5 (0.3–8)
Incontinence
Gas			26%	12.6%
Liquid stool		29%‡	7%	10.3%
Solid stool			16%	5.8%
Use of pads	35%	18%		13.8%
Clustering of stools		44%		30.3%

*6 months after LAR.

†Side to end anastomosis.

‡Faecal/mucus leakage.

Figure 1.  The colonic J-pouch.

Table II.  Bowel function after colonic J-pouch and straight anastomosis.

							Incontinence
	Bowel frequency Number of stools/day Medium (range)		Stool Clustering		Urgency		Gas		Faeces
	J-P	Straight	J-P	Straight	J-P	Straight	J-P	Straight	J-P	Straight
Hallböök et al. [24]	2 (1.3–2.3)	3.5 (2.4–4.5)			7%*	45%*
Ho et al. [25]			25%	37%	13%	26%	0%	16%	0%	5%
Dehni et al. [27]	1.6 (1–5)	2.8 (1–9)	30%	71%			45%	55%	13%†	12%†

* Never or Sometimes able to defer defecation for >30 min.

† Incontinence for faeces.

Figure 2.  The coloplasty.

Figure 3.  The end-to-side anastomosis.

Table III.  Long term side effects of preoperative short course radiotherapy.

Study	Treatment	Surgery	Surgery + RT	P-values
Pollack et al. [51]	Faecal incontinence	26%	57%	p = 0.013
RCT. n= 252 ptt	Diarrhoea	9%	30%	p = 0.002
Birgisson et al. [52]	Bowel obstruction	1*	1.88*	p = 0.02
RCT. n= 1147 ptt	Nausea	1*	4.04*	p = 0.03
	Abdominal pain	1*	1.92*	p = 0.01
Peeters et al. [53]	Faecal incontinence	38%	62%	p < 0.001
RCT. n= 597 ptt	Use of pads	33%	56%	p < 0.001
	Anal blood loss	3%	11%	p = 0.004
	Mucus loss	15%	27%	p = 0.005

*RR (Relative risk).

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