Restorative reconstruction after TME for rectal Cancer is associated with significant bowel dysfunction from initial presentation

Abstract Background Patients often desire restorative reconstruction following total mesorectal excision (TME). Reconstruction has become synonymous with providing high quality rectal cancer care. However, the bowel functional outcomes of restoration from presentation are unknown. We aimed to evaluate the bowel functional effects of rectal cancer treatment from presentation through surveillance. Methods This was a retrospective cohort study from 2014 to 2019 using prospectively collected data. Patients underwent treatment for rectal adenocarcinoma including restorative reconstruction. Patients completed the validated Colorectal Functional Outcome questionnaire (COREFO) during clinic visits at: (1)presentation, (2)after neoadjuvant therapy, (3)after restoration of continuity, and (4)surveillance. Scores range 0–100 with a higher score indicating worse bowel function. Results 68 patients (age: 62 ± 12 years, 40% female) were included. The mean tumor height was 7 ± 4 cm with 85% symptomatic. Bowel function did not worsen from presentation to after neoadjuvant therapy in Total COREFO and most domain scores; there was improvement in frequency and stool-related aspects. Bowel function worsened in all scores from after neoadjuvant to restoration of continuity (mean anastomotic height: 5 ± 2 cm); there were similar findings between presentation and restoration of continuity. At surveillance, there was improvement in most domains compared with restoration of continuity. There remained significant worsening of incontinence, social impact, and need for medication scores at surveillance compared with presentation. Conclusion Restorative reconstruction after TME is associated with significant bowel dysfunction. For some patients, restorative reconstruction may not be high quality rectal cancer care.