title: Post-colectomy assessment of gastrointestinal function: a prospective study on colorectal cancer patients.
abstract: BACKGROUND
  Anatomical changes after intestinal resection and the effects of adjuvant treatment for colorectal cancer may lead to gastrointestinal disturbances. The aim of our study was to assess gastrointestinal function using validated health-related quality of life (HRQoL) questionnaires that are able to reliably quantify patients' symptoms.
  
  
  METHODS
  Two hundred and eighty-nine colorectal cancer patients underwent HRQoL assessment preoperatively and at 3,6 and 12 months postoperatively. They were evaluated with the Gastrointestinal Quality of Life Index (GIQLI) ["global" and "symptoms" scales and questions 3 ("bloating"), 4 ("excessive gas"), 6 ("gurgling noises"), 7 ("frequent bowel movements (BMs)"), 30 ("urgent BMs"), 31 ("diarrhea"), 32 ("constipation"), 36 ("uncontrolled stools")] and the European Organization for Research and Treatment of Cancer (EORTC) modules QLQ-C30 (symptom scales: "constipation" and "diarrhea") and QLQ-CR29 (symptom scales: "defecation problems," "incontinence," and "bloating").
  
  
  RESULTS
  GIQLI "global" and "symptom" indices and the majority of single-item scores and the EORTC QLQ-C30 "constipation" and "diarrhea" subscales showed significant postoperative improvement (p < 0.05). Females and younger age (<70 years) patients appeared to have worse postoperative gastrointestinal function. Rectal cancer patients had more "urgent BMs," "uncontrolled stools" and worse "global" and "symptom" scores at 3 months and more "diarrhea" at 3 and 6 months than colon cancer patients (p < 0.03). Right colectomy patients had less "excessive passage of gas," "constipation," and "uncontrolled stools" than left colectomy patients (3 months, p < 0.01). Anterior resection patients faced more gastrointestinal difficulties, especially in the first 6 months after surgery. Adverse effects related to stage and adjuvant treatment were predominant only at baseline (p < 0.05). GIQLI "diarrhea" and "constipation" scores were correlated with the respective EORTC QLQ-C30 domains (p = 0.0001).
  
  
  CONCLUSIONS
  Overall, gastrointestinal function is improved after colorectal cancer surgery. However, women and younger patients are at higher risk of postoperative gastrointestinal dysfunction.
authors.affiliation: Colorectal Unit, 1st Department of Propaedeutic Surgery, Hippocration Hospital, University of Athens Medical School, 7 Semitelou Street, 11528, Athens, Greece, georgetheocrs@live.com.
authors.forename: G E
authors.initials: GE
authors.lastname: Theodoropoulos
authors.forename: I G
authors.initials: IG
authors.lastname: Papanikolaou
authors.forename: T
authors.initials: T
authors.lastname: Karantanos
authors.forename: G
authors.initials: G
authors.lastname: Zografos
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003248:Constipation / Q000453:epidemiology / Q000209:etiology; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D041981:Gastrointestinal Tract / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D011446:Prospective Studies; D011788:Quality of Life; D017678:Sex Distribution; D018434:Sickness Impact Profile; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome