title: Risk factors for persistent anal incontinence after restorative proctectomy in rectal cancer patients with anal incontinence: prospective cohort study.
abstract: BACKGROUND
  This study evaluated the notion that preoperative anal incontinence might be a potent predictive factor for anal incontinence (AI) after restorative proctectomy in rectal cancer patients. The principal objective of this study was to determine the risk factors for persistent anal incontinence following restorative proctectomy.
  
  
  METHODS
  This study was designed as a single-center, prospective cohort study of a single group of 93 patients who had AI before restorative proctectomy for rectal cancer. The study group was re-evaluated for the presence of AI 12 months after restorative proctectomy or ileostomy takedown. Incontinence severity was determined using the Fecal Incontinence Severity Index (FISI). Logistic regression analysis was performed to identify the clinicopathologic factors associated with persistent AI.
  
  
  RESULTS
  Fifteen patients were excluded from analysis due to death within the 12 months after surgery (n = 7), no ileostomy repair (n = 5), loss to follow-up (n = 2), or previous treatment for anal incontinence (n = 1). At 12 months, 53 of 78 patients (67.9%) had persistent AI and 25 patients (32.1 %) had recovered. Multivariate analysis demonstrated that preoperative FISI scores higher than 30 (OR = 11.61, 95% CI 1.43-94.01, p = 0.022) and lower tumor location 5 cm or less from the anal verge (OR = 84.46, 95% CI 3.91-1822.85, p = 0.005) were independent factors for persistent AI.
  
  
  CONCLUSIONS
  Anal incontinence may persist after restorative proctectomy in rectal cancer patients with high preoperative incontinence scores and lower tumor location. Therefore, this information should be provided when restorative proctectomy is offered for rectal cancer patients.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do 463-707, Republic of Korea.
authors.forename: Taek-Gu
authors.initials: TG
authors.lastname: Lee
authors.forename: Sung-Bum
authors.initials: SB
authors.lastname: Kang
authors.forename: Seung Chul
authors.initials: SC
authors.lastname: Heo
authors.forename: Seung-Yong
authors.initials: SY
authors.lastname: Jeong
authors.forename: Kyu Joo
authors.initials: KJ
authors.lastname: Park
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D015331:Cohort Studies; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology*; D016737:Proctocolectomy, Restorative; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D011795:Surveys and Questionnaires