title: The long-term gastrointestinal functional outcomes following curative anterior resection in adults with rectal cancer: a systematic review and meta-analysis.
abstract: BACKGROUND
  Significant variability and a lack of transparency exist in the reporting of anterior resection outcomes.
  
  
  OBJECTIVE
  This study aimed to qualitatively analyze the long-term functional outcomes and assessment tools used in evaluating patients with rectal cancer following anterior resection, to quantify the incidence of these outcomes, and to identify risk factors for long-term incontinence.
  
  
  METHODS
  MEDLINE, Embase, and CINAHL were searched using the terms rectal neoplasms, resection, and gastrointestinal function.
  
  
  METHODS
  The studies included were in English and evaluated adults with rectal cancer, curative anterior resection, and a minimum 1-year follow-up. Patients with recurrent/metastatic disease were excluded. Of the 805 records identified, 48 articles were included.
  
  
  METHODS
  The intervention performed was anterior resection.
  
  
  METHODS
  The main outcome measure was incontinence (gas, liquid stool, and solid stool).
  
  
  RESULTS
  The histories of 3349 patients from 17 countries were summarized. Surgeries were conducted between 1978 to 2004 with a median follow-up of 24 months (interquartile range, 12, 57). Sixty-five percent of studies did not use a validated assessment tool. Reported outcomes and incidence rates were variable. The reported proportion of patients with incontinence ranged from 3.2% to 79.3%, with a pooled incidence of 35.2% (95% CI 27.9, 43.3). Risk factors for incontinence, identified by meta-regression, were preoperative radiation 0.009 and, in particular, short-course radiation (P = .006), and study quality (randomized controlled trial P = .004, observational P = .006).
  
  
  CONCLUSIONS
  The meta-analysis was limited by the significant heterogeneity of the primary data.
  
  
  CONCLUSIONS
  Functional outcomes are inconsistently assessed and reported and require common definitions, and the more regular use of validated assessment tools, as well. Preoperative radiation and, in particular, short-course radiation may be a strong risk factor for incontinence; however, further studies are needed.
authors: Department of General Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada. ascheer@toh.on.ca
authors: Adena S
authors: AS
authors: Scheer
authors: Robin P
authors: RP
authors: Boushey
authors: Shuyin
authors: S
authors: Liang
authors: Steve
authors: S
authors: Doucette
authors: Annette M
authors: AM
authors: O'Connor
authors: David
authors: D
authors: Moher
mesh_terms: D000328:Adult; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome