Annals of Surgical Oncology

, Volume 24, Issue 12, pp 3596–3603 | Cite as

Predictors of Bowel Function in Long-term Rectal Cancer Survivors with Anastomosis

  • Mubarika Alavi
  • Christopher S. Wendel
  • Robert S. Krouse
  • Larissa Temple
  • Mark C. Hornbrook
  • Joanna E. Bulkley
  • Carmit K. McMullen
  • Marcia Grant
  • Lisa J. Herrinton
Colorectal Cancer



Bowel function in long-term rectal cancer survivors with anastomosis has not been characterized adequately. We hypothesized that bowel function is associated with patient, disease, and treatment characteristics.


The cohort study included Kaiser Permanente members who were long-term (≥5 years) rectal cancer survivors with anastomosis. Bowel function was scored using the self-administered, 14-item Memorial Sloan-Kettering Cancer Center Bowel Function Index. Patient, cancer, and treatment variables were collected from the electronic medical chart. We used multiple regression to assess the relationship of patient- and treatment-related variables with the bowel function score.


The study included 381 anastomosis patients surveyed an average 12 years after their rectal cancer surgeries. The total bowel function score averaged 53 (standard deviation, 9; range, 31–70, higher scores represent better function). Independent factors associated with worse total bowel function score included receipt of radiation therapy (yes vs. no: 5.3-unit decrement, p < 0.0001), tumor distance from the anal verge (≤6 cm vs. >6 cm: 3.2-unit decrement, p < 0.01), and history of a temporary ostomy (yes vs. no: 4.0-unit decrement, p < 0.01). One factor measured at time of survey was also associated with worse total bowel function score: ever smoking (2.3-unit decrement, p < 0.05). The regression model explained 20% of the variation in the total bowel function score.


Low tumor location, radiation therapy, temporary ostomy during initial treatment, and history of smoking were linked with decreased long-term bowel function following an anastomosis. These results should improve decision-making about surgical options.



The authors thank Mary Wagner, Administrative Assistant, University of Arizona Cancer Center, for help with this work.


Supported by Grant R01 CA106912, “Health-Related Quality of Life in Colorectal Cancer Survivors With Stomas,” from the National Cancer Institute, National Institutes of Health, in collaboration with resources and the use of facilities provided at the Southern Arizona Veterans Affairs Health Care System, Tucson, Arizona, and Kaiser Permanente.


The views expressed in this report are those of the authors and do not necessarily represent the views of the University of Arizona or Kaiser Permanente.


Dr. Herrinton has had research contracts in the past 3 years with MedImmune that was unrelated to this study. The other authors have no disclosures.

Ethical Approval

All studies were approved by the Institutional Review Boards of the University of Arizona and Kaiser Permanente.


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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Mubarika Alavi
    • 1
  • Christopher S. Wendel
    • 2
  • Robert S. Krouse
    • 3
  • Larissa Temple
    • 4
  • Mark C. Hornbrook
    • 5
  • Joanna E. Bulkley
    • 5
  • Carmit K. McMullen
    • 5
  • Marcia Grant
    • 6
  • Lisa J. Herrinton
    • 1
  1. 1.Division of ResearchKaiser Permanente Northern CaliforniaOaklandUSA
  2. 2.University of Arizona College of MedicineTucsonUSA
  3. 3.CMC Veterans Affairs Medical CenterPhiladelphiaUSA
  4. 4.University of Rochester Medical CenterRochesterUSA
  5. 5.Kaiser Permanente Center for Health ResearchPortlandUSA
  6. 6.City of Hope/Beckman Research InstituteDuarteUSA

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