Long-term Bowel and Stoma Function Following Colorectal Cancer Surgery

Abstract

Aim: The aim of this thesis was to explore bowel and stoma function following colorectal cancer surgery, to investigate associated distress and identify possible risk factors. Methods: Papers I, II, and IV were based on two prospective, observational cohort studies focusing on rectal cancer (I, II) and colon cancer (IV). Paper I included patients who had an anastomosis, while paper II included patients with a permanent stoma. Paper III was a registry-based cross-sectional study. Results: Paper I found that more than half of the patients experienced significant bowel dysfunction, identifying a defunctioning stoma as a risk factor. Distress was common, decreasing over time. In paper II, most patients reported high stoma functionality and acceptance, only one-fifth experienced distress. Paper III demonstrated that the anastomotic configuration had equal impact on bowel dysfunction. Paper IV showed that most patients maintained intact bowel function after colon resection. After right-sided resections loose stools were common and associated with distress, as was incontinence. Conclusion: Providing preoperative information, managing expectations, and ensuring early detection and treatment of symptoms are important to achieve optimal function and minimise distress. For patients with minimal or no impairment, extensive follow-up may be unnecessary.