A cross-sectional review of reporting variation in post-operative bowel dysfunction following rectal cancer surgery

Background: Postoperative bowel dysfunction affects quality of life after sphincter-preserving rectal cancer surgery, but the extent of the problem is not clearly defined due to inconsistent outcome measures used to characterise the condition. Objective: The purpose of this study was to assess variation in reporting of postoperative bowel dysfunction and make recommendations for standardisation in future studies. If possible, a quantitative synthesis of bowel dysfunction symptoms was planned. Data Sources: MEDLINE and EMBASE databases and the Cochrane Library were queried between 2004-2015. Study Selection: The studies selected reported at least one component of bowel dysfunction following resection of rectal cancer. Main Outcome Measures: The main outcome measures were reporting, measurement and definition of post-operative bowel dysfunction. Results: Of 5428 studies identified, 234 met inclusion criteria. Widely reported components of bowel dysfunction were incontinence to stool (227/234; 97.0%), frequency (168/234; 71.8%) and incontinence to flatus (158/234; 67.5%). Urgency and stool clustering were reported less commonly, with rates of 106/234 (45.3%) and 61/234 (26.1%). Bowel dysfunction measured as a primary outcome was associated with better reporting (OR: 3.49; 95% CI: 1.99–6.23; P<0.001). Less than half of the outcomes were assessed using a dedicated research tool (337/720; 46.8%), with the remaining descriptive measures infrequently defined (56/383; 14.6%). Limitations: Heterogeneity in the reporting, measurement and definition of post-operative bowel dysfunction precluded pooling of results and limited interpretation. Conclusion: Considerable variation exists in the reporting and definition of postoperative bowel dysfunction. These inconsistencies preclude reliable estimates of incidence and meta-analysis. A recently validated scoring tool for postoperative bowel dysfunction, the LARS score, should be endorsed for future studies.