Fecal incontinence after total mesorectal excision for rectal cancer-impact of potential risk factors and pelvic intraoperative neuromonitoring.
BACKGROUND
Fecal incontinence frequently occurs after total mesorectal excision for rectal cancer. This prospective study analyzed predictive factors and the impact of pelvic intraoperative neuromonitoring at different follow-up intervals.


METHODS
Fifty-two patients were included undergoing total mesorectal excision for rectal cancer, and 29 under control of pelvic intraoperative neuromonitoring. Fecal incontinence was assessed using the Wexner Score at 3 and 6 months after stoma closure (follow-ups 1 and 2) as well as 1 and 2 years after surgery (follow-ups 3 and 4). Risk factors were identified by means of logistic regression.


RESULTS
New onset of fecal incontinence was significantly lower in the neuromonitoring group at each follow-up (follow-up 1: 2 of 29 patients (7%) vs. 8 of 23 (35%), (p = 0.014); follow-up 2: 3 of 29 (10%) vs. 9 of 23 (39%), (p = 0.017); follow-up 3: 5 of 29 (17%) vs. 11 of 23 (48%), p = 0.019; follow-up 4: 6 of 28 (21%) vs. 11 of 22 (50%), p = 0.035). Non-performance of neuromonitoring was found to be an independent predictor for fecal incontinence throughout the survey. Neoadjuvant chemoradiotherapy was an independent predictor in the further course 1 and 2 years after surgery.


CONCLUSIONS
Performance of pelvic intraoperative neuromonitoring is associated with significantly lower rates of fecal incontinence. Neoadjuvant chemoradiotherapy was found to have negative late effects. This became evident 1 year after surgery.
['Kauff|Daniel W|DW|', 'Roth|Yvonne D S|YDS|', 'Bettzieche|Rika S|RS|', 'Kneist|Werner|W|http://orcid.org/0000-0002-7219-0523']
D000368:Aged D059248:Chemoradiotherapy D005242:Fecal Incontinence D005260:Female D005500:Follow-Up Studies D006801:Humans D064795:Intraoperative Neurophysiological Monitoring D008297:Male D008875:Middle Aged D020360:Neoadjuvant Therapy D010388:Pelvis D011178:Postgastrectomy Syndromes D000078542:Proctectomy D011446:Prospective Studies D012004:Rectal Neoplasms D012307:Risk Factors
Fecal incontinence Rectal cancer Autonomic nervous system Intraoperative monitoring Neoadjuvant therapy