title: A prospective case control study of functional outcomes and related quality of life after colectomy for neoplasia.
abstract: OBJECTIVE
  Our aim was to assess bowel function and its effect on overall quality of life (QOL) when compared to healthy controls after colectomy.
  
  
  METHODS
  Patients undergoing resection of colorectal neoplasia were recruited pre-operatively and followed up at 6 and 12 months, to assess 'early' bowel function. Patients who underwent surgery 2 to 4 years previously were recruited for assessment of 'intermediate' bowel function. Healthy relatives were recruited as controls. The Memorial Sloan-Kettering Cancer Centre and EQ-5D questionnaires were used to assess bowel function and QOL, respectively. Statistical assessment included regression analyses, parametric and non-parametric tests. The association between QOL and Memorial Sloan-Kettering Cancer Centre (MSKCC) scores was evaluated using Spearman's rank correlation.
  
  
  RESULTS
  Ninety-one patients were recruited for assessment of 'early' and 85 for 'intermediate' bowel function. There were 85 controls. Patients had a significantly higher number of bowel movements at each follow-up (p < 0.001). At 12 months after surgery, patients reported difficulty with gas-stool discrimination. The 'intermediate' group were found to have lower scores for flatus control (<0.001) and total frequency score (p 0.03), indicating worse function. Patients with higher total MSKCC scores, no symptoms of urgency and those able to control flatus reported better QOL (p 0.006, 0.007 and 0.005, respectively) at 6 and 12 months. Gas-stool differentiation and complete evacuation correlated with better QOL in the 'intermediate' bowel function group (p 0.02 and 0.02, respectively).
  
  
  CONCLUSIONS
  Colonic resection adversely affects elements of bowel function up to 4 years after surgery. Good colonic function, represented by higher MSKCC scores, correlates with better QOL.
authors.affiliation: Department of Surgery, St. Mark's Hospital, Watford Road, Harrow, HA1 3UJ, UK.|Division of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK.
authors.forename: Adela
authors.identifier: http://orcid.org/0000-0003-3759-8440
authors.initials: A
authors.lastname: Brigic
authors.affiliation: Research and Development Department, North West London Hospitals Trust, Watford Road, London, HA1 3UJ, UK.
authors.forename: Samia
authors.initials: S
authors.lastname: Sakuma
authors.affiliation: Department of Surgery, Oxford Radcliffe Hospitals, Headley Way, Oxford, OX3 9DU, UK.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Lovegrove
authors.affiliation: Research and Development Department, North West London Hospitals Trust, Watford Road, London, HA1 3UJ, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Bassett
authors.affiliation: Department of Surgery, St. Mark's Hospital, Watford Road, Harrow, HA1 3UJ, UK.|Division of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK.|Department of Surgery and Cancer, St. Mary's Hospital London, W2 1NY, London, UK.
authors.forename: Omar
authors.initials: O
authors.lastname: Faiz
authors.affiliation: Department of Surgery, St. Mark's Hospital, Watford Road, Harrow, HA1 3UJ, UK.|Division of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Clark
authors.affiliation: Department of Surgery, Oxford Radcliffe Hospitals, Headley Way, Oxford, OX3 9DU, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Mortensen
authors.affiliation: Department of Surgery, St. Mark's Hospital, Watford Road, Harrow, HA1 3UJ, UK. robin.kennedy@nhs.net.|Division of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK. robin.kennedy@nhs.net.
authors.forename: Robin H
authors.initials: RH
authors.lastname: Kennedy
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000601:surgery*; D003672:Defecation; D003710:Demography; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Bowel function; Colorectal neoplasia; MSKCC questionnaire; Quality of life