Restorative reconstruction after total mesorectal excision for rectal cancer is associated with significant bowel dysfunction from initial presentation

Abstract

Background Patients often desire restorative reconstruction following total mesorectal excision. Reconstruction has become synonymous with providing high-quality rectal cancer care. However, the bowel functional outcomes of restoration from presentation are unknown. We aimed to evaluate the bowel functional effects of rectal cancer treatment from presentation through surveillance. Methods This was a retrospective cohort study from 2014 to 2019 using prospectively collected data. Patients underwent treatment for rectal adenocarcinoma including restorative reconstruction. Patients completed the validated Colorectal Functional Outcome questionnaire during clinic visits (1) at presentation, (2) after neoadjuvant therapy, (3) after restoration of continuity, and (4) at surveillance. Scores range from 0 to 100 with a higher score indicating worse bowel function. Results Sixty-eight patients (age: 62 ± 12 years, 40% female) were included. The mean tumor height was 7 ± 4 cm with 85% symptomatic. Bowel function did not worsen from presentation to after neoadjuvant therapy in Total Colorectal Functional Outcome and most domain scores; there was improvement in frequency and stool-related aspects. Bowel function worsened in all scores from after neoadjuvant to restoration of continuity (mean anastomotic height: 5 ± 2 cm); there were similar findings between presentation and restoration of continuity. At surveillance, there was improvement in most domains compared with restoration of continuity. There remained significant worsening of incontinence, social impact, and need for medication scores at surveillance compared with presentation. Conclusion Restorative reconstruction after total mesorectal excision is associated with significant bowel dysfunction. For some patients, restorative reconstruction may not be high-quality rectal cancer care.

Long‐term bowel function patient‐reported outcomes after successful chemoradiation for carcinoma of the anal canal

“…Our prior work in the rectal cancer population found no difference in bowel function from presentation to after neoadjuvant therapy. However, there was a significant worsening of incontinence, social impact and need for medication scores after restoration of continuity and at surveillance [14]. This cannot be explained by differences in radiation patterns and doses for anal canal SCC and rectal cancer.…”

Patient reported outcome measures (PRO) in colorectal surgery

“…The results demonstrated that restorative reconstruction was associated with significant worsening of bowel function compared to baseline bowel function that persists at six-months after ileostomy reversal. The authors concluded that restorative reconstruction after total mesorectal excision is associated with worsening of bowel dysfunction when compared to baseline that is persistent [ 35 ].…”

Shared Decision-Making, Sphincter Preservation, and Rectal Cancer Treatment: Identifying and Executing What Matters Most to Patients

“…[98][99][100][101] Moreover, longitudinal patient-reported outcome tracking for people treated for rectal cancer is vital to understand changes in bowel function and other things that matter most for patients. 102 One mechanism to measure high-quality consultation could be to develop and add a patient-reported outcome regarding communication and decision making into the National Accreditation Program for Rectal Cancer. Taken together, this additional data could lead to development of best practices in shared decision making for rectal cancer to include standardized patient information sources that can be tailored for individual learning styles, clinical, social, and functional factors; surgeon communication training; and mechanisms to evaluate and improve on this process.…”

“…98 99 100 101 Moreover, longitudinal patient-reported outcome tracking for people treated for rectal cancer is vital to understand changes in bowel function and other things that matter most for patients. 102…”

“…Future studies and communication training could incorporate work by breast surgeons and urologic oncologists who have a longer track record of communication training and shared decisionmaking efforts in their respective preference-sensitive clinical areas [98][99][100][101]. Moreover, longitudinal patient-reported outcome tracking for people treated for rectal cancer is vital to understand changes in bowel function and other things that matter most for patients 102. One mechanism to measure high-quality consultation could be to develop and add a patient-reported outcome regarding communication and decision making into the National Accreditation Program for Rectal Cancer.…”