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Evaluation of Long-term Anorectal Function After Low Anterior Resection: A 5-Year Follow-up of a Randomized Multicenter Trial

Floodeen, Hannah M.D.1; Lindgren, Rickard M.D., Ph.D.1; Hallböök, Olof M.D., Ph.D.2; Matthiessen, Peter M.D., Ph.D.1,3

doi: 10.1097/DCR.0000000000000197
Original Contributions: Colorectal/Anal Neoplasia

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.

1Department of Surgery, Örebro University Hospital, Örebro, Sweden

2Department of Surgery, Linköping University Hospital, Linköping, Sweden

3Örebro University, Örebro, Sweden

Funding/Support: This work was supported by a grant from the Örebro County Council (Örebro, Sweden).

Financial Disclosure: None reported.

Presented at the Swedish Surgical Week, Linköping, Sweden, August 20 to 24, 2012 and The European Society of Coloproctology, Belgrade, Serbia, September 25 to 27, 2013.

Correspondence: Hannah Floodeen, M.D., Department of Surgery, Örebro University Hospital, Södra Grev Rosengatan, 70185 Örebro, Sweden. E-mail:

© 2014 The American Society of Colon and Rectal Surgeons