A Statistical Analysis of Bowel Function and Quality of Life after Anterior Resection for Rectal Cancer

Abstract

Abstract A Statistical Analysis of Bowel Function and Quality of Life after Anterior Resection for Rectal Cancer Amanda Andersson, Degree Project in Medicine, 2019 Department of Surgery, Sahlgrenska Academy at University of Gothenburg, Sweden Supervisors: Professor Eva Angenete and Associate Professor Marie-Louise Lydrup Background Colorectal cancer is the third most common cancer in Sweden and about a third is localized within the rectum. During the last decades, the 5-year survival rate has increased markedly due to improved oncological and surgical treatment. The postoperative morbidity is yet substantial, in terms of bowel dysfunction and impaired quality of life, motivating future research in this field. Objective The aim of this study was to investigate if the surgical technique partial mesorectal excision is superior to total mesorectal excision regarding bowel function and quality of life in patients with rectal cancer. Method The cohort was identified through the Swedish Colorectal Cancer Registry and consisted of 1495 patients treated with anterior resection for rectal cancer 2007-2013 at 15 Swedish hospitals. All patients alive received questionnaires about bowel function and quality of life. Bowel function was measured with a scoring system based on clusters of postoperative bowel symptoms, called low anterior resection syndrome (LARS), where "major LARS" represents the most severe form. Patients no longer alive or with permanent stoma were excluded (n=483) and registry data was completed with data from medical records. Univariate analyses for included patients were performed with Chi-square test for categorical data and ANOVA/Mann Whitney U test for continues data. The association between surgical procedure and bowel dysfunction was evaluated using binary logistic regression, with adjustments for potential confounders. Results Of the 254 patients suffering from major LARS, 81,1% were operated with total mesorectal excision and 18.9% with partial mesorectal excision (p<0.001). Odds Ratio for major LARS comparing total- to partial mesorectal excision was 1.82 (95% CI 1.12 to 2.95, p=0.016). Partial mesorectal excision was also associated with better social function and less diarrhea (p<0.001). Conclusion Patients operated with anterior resection for rectal cancer has a higher risk of developing severe bowel dysfunction, social dysfunction and higher frequency of diarrhea when treated with