World Journal of Surgery

, Volume 35, Issue 8, pp 1918–1924 | Cite as

Risk Factors for Persistent Anal Incontinence After Restorative Proctectomy in Rectal Cancer Patients with Anal Incontinence: Prospective Cohort Study

  • Taek-Gu Lee
  • Sung-Bum KangEmail author
  • Seung Chul Heo
  • Seung-Yong Jeong
  • Kyu Joo Park



This study evaluated the notion that preoperative anal incontinence might be a potent predictive factor for anal incontinence (AI) after restorative proctectomy in rectal cancer patients. The principal objective of this study was to determine the risk factors for persistent anal incontinence following restorative proctectomy.


This study was designed as a single-center, prospective cohort study of a single group of 93 patients who had AI before restorative proctectomy for rectal cancer. The study group was re-evaluated for the presence of AI 12 months after restorative proctectomy or ileostomy takedown. Incontinence severity was determined using the Fecal Incontinence Severity Index (FISI). Logistic regression analysis was performed to identify the clinicopathologic factors associated with persistent AI.


Fifteen patients were excluded from analysis due to death within the 12 months after surgery (n = 7), no ileostomy repair (n = 5), loss to follow-up (n = 2), or previous treatment for anal incontinence (n = 1). At 12 months, 53 of 78 patients (67.9%) had persistent AI and 25 patients (32.1 %) had recovered. Multivariate analysis demonstrated that preoperative FISI scores higher than 30 (OR = 11.61, 95% CI 1.43-94.01, p = 0.022) and lower tumor location 5 cm or less from the anal verge (OR = 84.46, 95% CI 3.91-1822.85, p = 0.005) were independent factors for persistent AI.


Anal incontinence may persist after restorative proctectomy in rectal cancer patients with high preoperative incontinence scores and lower tumor location. Therefore, this information should be provided when restorative proctectomy is offered for rectal cancer patients.


Rectal Cancer Anal Verge Rectal Cancer Patient Anal Incontinence Anastomotic Technique 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.


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Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Taek-Gu Lee
    • 1
  • Sung-Bum Kang
    • 1
    Email author
  • Seung Chul Heo
    • 2
  • Seung-Yong Jeong
    • 3
  • Kyu Joo Park
    • 3
  1. 1.Department of Surgery, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamRepublic of Korea
  2. 2.Department of Surgery, Seoul National University College of MedicineSeoul National University Hospital, and Boramae HospitalSeoulRepublic of Korea
  3. 3.Department of Surgery, Seoul National University College of MedicineSeoul National University HospitalSeoulRepublic of Korea

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