[Can continence function after rectal resection be prognostically estimated?].
OBJECTIVE
To determine clinical and physiologic parameters enabling the prognosis of continence after protective ileostomy closure secondary to rectal resection for rectal cancer.


METHODS
Patients who had undergone rectal resection (n = 65, of whom 24 had had radiochemotherapy) were evaluated by clinical examination, anorectal manometry and orthograde contrast enema before ileostomy closure. Continence was evaluated by clinical findings 91 +/- 52 weeks after stoma closure with the help of standardized questionnaires and classified according to the Wexner continence score. The relationship between findings before stoma closure and continence score was calculated with Pearson's correlation coefficient.


RESULTS
Correlations were found to be significant between the continence score and the level of anastomosis (r = -0.58, p < 0.001), median resting pressure (r = -0.52, p < 0.001), rectal compliance (r = -0.43, p < 0.001). Additionally, radiochemotherapy impairs continence (p = 0.0001). Correlations were not significant between continence and functional sphincter length, squeeze pressure, threshold for perception, urge and maximal tolerable volume, and continence for semiliquid contrast medium.


CONCLUSIONS
Incontinence after rectum resection is multifactorial: the level of anastomosis, resting pressure, rectal compliance and radiochemotherapy all play a dominant role. Based on these findings, the continence score can be calculated before closure of a diverting ileostomy by applying multivariate analysis with the help of the following formula: Continence score = 18.23 - 0.94 x level of anastomosis - 0.18 x resting pressure + 3.72 x radiochemotherapy.
Stadelmaier
U
U
Chirurgische Klinik mit Poliklinik, Universität Erlangen-Nürnberg. Uwe.Stadelmaier@chir.imed.uni-erlangen.de
Bittorf
B
B
Meyer
M
M
Hohenberger
W
W
Matzel
K E
KE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003187:Compliance; D005242:Fecal Incontinence / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007081:Ileostomy; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D012007:Rectum / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation