Long-term Bowel Dysfunction and Decline in Quality of Life Following Surgery for Colon Cancer: Call for Personalized Screening and Treatment

Sanne J Verkuijl*, Edgar J B Furnée, Wendy Kelder, Christiaan Hoff, Daniel A Hess, Fennie Wit, Ronald J Zijlstra, Monika Trzpis, Paul M A Broens

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    2 Citations (Scopus)
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    Abstract

    BACKGROUND: Differences in long-term outcomes regarding types of colon resections are inconclusive, precluding preoperative patient counseling and effective screening and personalized treatment of postoperative bowel dysfunction during follow-up.

    OBJECTIVE: To compare long-term bowel function and quality of life in patients who underwent right or left hemicolectomy, or sigmoid colon resection.

    DESIGN: A multicenter cross-sectional study.

    SETTINGS: Seven Dutch hospitals participated.

    PATIENTS: Included patients underwent right or left hemicolectomy, or sigmoid colon resection without construction of a permanent stoma between 2009 and 2015. Deceased, mentally impaired, or patients living abroad were excluded. Eligible patients were sent the validated Defecation and Fecal Continence and Short-Form 36 questionnaires.

    MAIN OUTCOME MEASURES: Constipation, fecal incontinence (both Rome IV criteria), separate bowel symptoms, and generic quality of life were assessed.

    RESULTS: Included were 673 right hemicolectomy, 167 left hemicolectomy, and 284 sigmoid colon resection patients. Median follow-up was 56 months (IQR 41-80). Sigmoid colon resection increased the likelihood of constipation compared to right and left hemicolectomy (OR, 2.92, 95% CI, 1.80-4.75, p < 0.001 and OR 1.93, 95% CI, 1.12-3.35, p = 0.019). Liquid incontinence and fecal urgency increased following right hemicolectomy compared to sigmoid colon resection (OR, 2.15, 95% CI, 1.47-3.16, p < 0.001 and OR 2.01, 95% CI, 1.47-2.74, p < 0.001). Scores on quality of life domains were significantly lower following right hemicolectomy.

    LIMITATIONS: Due to the cross-sectional design, longitudinal data are still lacking.

    CONCLUSIONS: Different long-term bowel function problems occur following right or left hemicolectomy, or sigmoid colon resection. The latter seems to be associated with more constipation than right or left hemicolectomy. Liquid incontinence and fecal urgency seem to be associated with right hemicolectomy, which may explain the decline in physical and mental generic quality of life of these patients. See Video Abstract at http://links.lww.com/DCR/C13.

    Original languageEnglish
    Pages (from-to)1531-1541
    Number of pages11
    JournalDiseases of the Colon and Rectum
    Volume65
    Issue number12
    Early online date19-Aug-2022
    DOIs
    Publication statusPublished - Dec-2022

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