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

doi:10.1097/DCR.0000000000002377

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

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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 language	English
Pages (from-to)	1531-1541
Number of pages	11
Journal	Diseases of the Colon and Rectum
Volume	65
Issue number	12
Early online date	19-Aug-2022
DOIs	https://doi.org/10.1097/DCR.0000000000002377
Publication status	Published - Dec-2022

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Verkuijl, S. J., Furnée, E. J. B., Kelder, W., Hoff, C., Hess, D. A., Wit, F., Zijlstra, R. J., Trzpis, M., & Broens, P. M. A. (2022). Long-term Bowel Dysfunction and Decline in Quality of Life Following Surgery for Colon Cancer: Call for Personalized Screening and Treatment. Diseases of the Colon and Rectum, 65(12), 1531-1541. https://doi.org/10.1097/DCR.0000000000002377

@article{0805bd36ee384bf9b878cff4e36097de,

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

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.",

author = "Verkuijl, {Sanne J} and Furn{\'e}e, {Edgar J B} and Wendy Kelder and Christiaan Hoff and Hess, {Daniel A} and Fennie Wit and Zijlstra, {Ronald J} and Monika Trzpis and Broens, {Paul M A}",

note = "Copyright {\textcopyright} 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Colon and Rectal Surgeons.",

year = "2022",

month = dec,

doi = "10.1097/DCR.0000000000002377",

language = "English",

volume = "65",

pages = "1531--1541",

journal = "Diseases of the Colon and Rectum",

issn = "0012-3706",

publisher = "Lippincott Williams and Wilkins",

number = "12",

}

TY - JOUR

T1 - Long-term Bowel Dysfunction and Decline in Quality of Life Following Surgery for Colon Cancer

T2 - Call for Personalized Screening and Treatment

AU - Verkuijl, Sanne J

AU - Furnée, Edgar J B

AU - Kelder, Wendy

AU - Hoff, Christiaan

AU - Hess, Daniel A

AU - Wit, Fennie

AU - Zijlstra, Ronald J

AU - Trzpis, Monika

AU - Broens, Paul M A

PY - 2022/12

Y1 - 2022/12

N2 - 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.

AB - 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.

U2 - 10.1097/DCR.0000000000002377

DO - 10.1097/DCR.0000000000002377

M3 - Article

C2 - 35982522

SN - 0012-3706

VL - 65

SP - 1531

EP - 1541

JO - Diseases of the Colon and Rectum

JF - Diseases of the Colon and Rectum

IS - 12

ER -

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

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