Introduction Aim Functional outcomes after elective colectomy (right, left or sigmoid) for neoplasia are poorly reported in the literature. This study evaluates bowel function and related quality of life in patients 2 – 4 years after hemicolectomy, comparing the results to healthy controls.
Methods Eligible patients were identified from prospectively maintained colorectal databases at two teaching hospitals. Patients were recruited during regular follow up visits or by telephone interview. Patient relatives with an intact colon were recruited as controls. Study exclusion criteria were poor cognitive ability, inflammatory bowel disease, metastatic disease, previous pelvic radiation, prior colonic, stomach or small bowel resection, bypass surgery, vagotomy, an existing stoma and anal incontinence. The Memorial Sloan-Kettering Cancer Centre (MSKCC) questionnaire was used to assess bowel function and the EQ-5D questionnaire to assess quality of life (QOL). Parametric and non-parametric tests were used with log transformation and regression methods for skewed data. Association between EQ-5D and MSKCC scores was examined with Spearman’s rank correlation.
Results A total of 85 patients (mean age 69 +/- 11.2 years) and 85 controls (mean age 58.2 +/- 13.4 years) were recruited in 12 months. Patients reported a significantly higher number of bowel movements per day than controls (2 versus 1, P < 0.001). Initial analysis suggested that patients had a significantly lower total MSKCC score (group difference mean –3.1, CI –5.8 to –0.4, p = 0.02), indicating worse bowel function in the patient group. Following adjustment for age, sex and co-morbidities, differences in total score were no longer significant, but the patient group had a lower score for the frequency subscale and the ability to control flatus (p = 0.008 and p = < 0.001). MSKCC frequency scores were worse after right-sided resections (p = 0.03). High scores for complete emptying and the differentiation between wind and solid had a positive correlation with better QOL (p = 0.007 and 0.02 respectively). There was a non-significant decrease in the overall QOL (EQ-5D p = 0.6, EQ-VAS p = 0.12) following hemicolectomy compared with controls.
Conclusion Colonic resection has an adverse effect on bowel frequency with worse outcomes following right hemicolectomy. Good colonic function, as assessed by the MSKCC questionnaire, is associated with better QOL.
Disclosure of Interest None Declared
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