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. 2021 Sep 21;6(1):101-108.
doi: 10.1002/ags3.12505. eCollection 2022 Jan.

Defecation disorder and anal function after surgery for lower rectal cancer in elderly patients

Takahiro Korai  1 , Emi Akizuki  1 , Kenji Okita  1 , Toshihiko Nishidate  1 , Koichi Okuya  1 , Yu Sato  1 , Atsushi Hamabe  1 , Masayuki Ishii  1 , Takayuki Nobuoka  1 , Ichiro Takemasa  1
Affiliations

Defecation disorder and anal function after surgery for lower rectal cancer in elderly patients

Takahiro Korai et al. Ann Gastroenterol Surg. .

Abstract

Aim: This study aims to investigate the association of patient age with defecation disorders and anal function after lower rectal cancer surgery.

Methods: We retrospectively reviewed the data of 141 consecutive patients with lower rectal cancer who underwent sphincter-preserving operation. The patients were classified into five categories by age thresholds at 65, 70, 75, 80, and 85 years, for disaggregate analysis. Anal manometry was used for measuring the maximum resting pressure, high-pressure zone, and maximum squeeze pressure. Anal manometry was performed preoperatively and at 3, 6, 9, and 12 months postoperatively. The Wexner and low anterior resection syndrome scores were assessed at 1, 3, 6, 9, and 12 months after rectal surgery or stoma closure for patients with ileostomy.

Results: The data of 117 patients were reviewed. No significant differences were found between the younger and elderly groups in any characteristics across the six age groups. The preoperative intra-anal pressures of the elderly patients were slightly lower than those of the younger patients; however, there was no significant difference in the course of postoperative intra-anal pressures. Defecation disorder, as measured by the Wexner and low anterior resection syndrome scores, improved significantly in elderly patients compared to younger patients.

Conclusion: There was no significant difference in the course of postoperative intra-anal pressures between the elderly and younger patients. However, defecation disorders in elderly patients significantly improved compared with younger patients. Sphincter-preserving operation can be a viable treatment option for active elderly patients.

Keywords: elderly; intra‐anal pressures; low anterior resection syndrome; rectal cancer; sphincter‐preserving operation.

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Conflict of interest statement

Conflict of interest: Authors declare no conflict of interest for this article. Ethical statements: The protocol for this research project has been approved by a suitably constituted Ethics Committee of Sapporo Medical University and it conforms to the provisions of the Declaration of Helsinki (Committee of Sapporo Medical University, Approval No. 312‐130). The requirement for informed consent was waived due to the retrospective nature of this study.

Figures

FIGURE 1
FIGURE 1
Study flowchart. Among 141 consecutive patients who underwent SPO for lower rectal cancer, 117 are included in this study. The patients were classified into six groups according to the following age thresholds: <65, 65‐69, 70‐74, 75‐79, 80‐84, and >85 years. SPO, sphincter‐preserving operation
FIGURE 2
FIGURE 2
Analysis of changes over the time of intra‐anal pressure in the six groups. There was no difference in the postoperative time course between the six groups, as revealed by the repeated measures analysis of variance. MRP, maximum resting pressure; HPZ, high‐pressure zone; MSP, maximum squeeze pressure
FIGURE 3
FIGURE 3
Analysis of changes over the time of Wexner and LARS scores in the six groups. The Wexner score and LARS score are measured at 1, 3, 6, 9, and 12 months after rectal surgery or stoma closure for patients with ileostomy. In all six groups, both the Wexner and LARS scores improved over time. Moreover, both scores were significantly more improved over time in the elderly group than in the younger group, as revealed by the repeated measures analysis of variance. LARS, low anterior resection syndrome
FIGURE 4
FIGURE 4
Wexner and LARS scores at 12 months after SPO. The Wexner scores and LARS scores showed a significant difference between the groups based on the repeated measures analysis of variance; therefore, a post‐hoc Dunnett's multiple comparison test was performed. Both the Wexner and the LARS score showed a significant improvement in most age groups at 12 months postoperatively when using 1 month postoperatively as a control. LARS, low anterior resection syndrome; SPO, sphincter‐preserving operation; *P < .05
See this image and copyright information in PMC

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