Bowel Function After Rectal Cancer Surgery: A Review of the Evidence

Impaired bowel function can profoundly affect quality of life. Multiple studies have looked at contributing factors to bowel function after rectal cancer surgery, using various measures in its assessment. The objective of this article was to review and summarize existing studies in the literature on bowel function after rectal cancer surgery. The major contributing factors to bowel function are reconstructive techniques and radiation therapy. Colonic J-pouch has been thoroughly studied and provides the best functional outcome, particularly with regard to bowel frequency. This technique may be impossible in obese patients with a narrow pelvis. Radiation therapy has an adverse effect on bowel outcomes, in particular, incontinence and bowel frequency, despite proven benefits in decreasing the risk of local recurrence. There is limited information on preoperative chemoradiation, but information to date suggests it is no different from short-course radiation. It is unclear whether a colonic J-pouch may compensate for radiation therapy's impact on bowel function. Bowel function can be improved by creating a colonic J-pouch. More research with detailed and standardized questionnaires is needed on patients who undergo radiation therapy, in particular, preoperative chemoradiation.