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Preoperative incremental maximum squeeze pressure as a predictor of fecal incontinence after very low anterior resection for low rectal cancer

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Abstract

Purpose

Very low anterior resection (VLAR) is performed widely, but some patients are left with fecal incontinence (FI), which compromises their quality of life (QOL) severely. This study sought to identify the predictive factors of postoperative FI after VLAR, which remain unclear.

Methods

We evaluated the anorectal manometry data of patients who underwent VLAR to identify the risk factors for postoperative FI among the various clinicopathological factors and manometric characteristics. FI and QOL were analyzed using the Wexner score and EORTC QLQ-C30, respectively.

Results

The subjects of this study were 40 patients who underwent VLAR for low rectal cancer between April, 2015 and May, 2018. There were 11 (27%) patients in the major-FI group and 29 (73%) in the minor-FI group. Multivariate analysis revealed that low preoperative incremental maximum squeeze pressure (iMSP) was an independent risk factor for postoperative major-FI. Postoperative QOL tended to be worse in the major-FI group.

Conclusions

Preoperative low iMSP increases the risk of major-FI and impaired QOL after VLAR. This highlights the importance of performing preoperative anorectal manometry to evaluate the patient’s anal function as well as to select the most appropriate operative procedure and early multifaceted treatment such as medication, rehabilitation, and biofeedback for postoperative FI.

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Authors and Affiliations

  1. Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Masatoshi Kochi, Hiroyuki Egi, Yuji Takakura, Kazuhiro Taguchi, Ikki Nakashima, Yusuke Sumi, Shintaro Akabane, Koki Sato, Hisaaki Yoshinaka & Hideki Ohdan

  2. Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan

    Tomohiro Adachi

  3. Department of Surgery, Chugoku-Rosai Hospital, Kure, Japan

    Shoichiro Mukai

  4. Advanced Medical Skills Training Center, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Minoru Hattori

Authors
  1. Masatoshi Kochi
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  2. Hiroyuki Egi
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  3. Tomohiro Adachi
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Corresponding author

Correspondence to Hiroyuki Egi.

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Masatoshi Kochi and his co-authors have no conflicts of interest to declare.

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Kochi, M., Egi, H., Adachi, T. et al. Preoperative incremental maximum squeeze pressure as a predictor of fecal incontinence after very low anterior resection for low rectal cancer. Surg Today 50, 516–524 (2020). https://doi.org/10.1007/s00595-019-01926-2

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  • DOI: https://doi.org/10.1007/s00595-019-01926-2

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