EP2005 - Impact of Bowel and Urinary Dysfunction on Quality of Life Following Segmental Colon Resection

Purpose/Background: The impact of bowel and urinary function on quality of life (QoL) following colon cancer resection has become increasingly important as the 5-year survival rate rises. Recent studies suggest bowel and bladder dysfunction as a result of colon resection with symptoms corresponding to the segment of colon resected. However, there is limited knowledge describing these changes and impact on quality of life for patients in the United States. We anticipated left colectomy would result in worse bowel and urinary function compared to right colectomy with a corresponding negative impact on quality of life.

Methods/Interventions: Following IRB approval, a retrospective chart review was conducted at a tertiary academic center to identify colon cancer patients who underwent segmental colectomy, without permanent stoma, between 2015 and 2023. Bowel and bladder dysfunction as well as quality of life was analyzed from patient responses to validated questionnaires collected during standard care at baseline, 6-months, and 18-months post-surgery. Surveys included: Memorial Sloan-Kettering Cancer Center Bowel Function Instrument (BFI), Urinary Distress Inventory (UDI-6), International Prostate Symptom Score (IPSS), EuroQol-5 Dimension Quality of Life (EQ-5D) with Visual Analogue Scale. A p-value < 0.05 was considered statistically significant.

Results/Outcomes: A total of 104 cases were identified, 29 in the right colectomy group and 75 in the left colectomy group, resulting in 1041 survey results. No difference in regard to sex, race or ethnicity was identified between groups. The right colectomy group was significantly older (68.6 v. 61.9, p=0.01) At baseline, patients undergoing right colectomy and left colectomy had no significant difference in BFI (73.5 v 73.6 p = 0.8). There was also no difference in BFI at 6 months (69.4 v. 70.0 p = 0.6) or 18 months (69.2 68.3 p=0.9) months post-surgery. Average BFI improved from baseline for each group by 6-months, and persisted at 18-months. Interestingly, female UDI-6 was significantly worse in the right colectomy cohort compared to left-sided patients (4.54 v. 1.85, p = 0.03), but no significant difference was observed post-surgery at either 6 or 18 months. No significant changes in IPSS were reported. Prior to surgery, right colectomy patients reported worse EQ-5D compared to left colectomy (0.79 v. 0.89, p=0.04). Following surgery both groups worsened at 6-months (0.73 v 0.85) and improved by 18-months post-surgery to a level greater than baseline (0.96 v. 0.93).

Conclusion/Discussion: Contrary to our hypothesis, up to 18 months after segmental colon resection, bowel function does not appear to differ significantly in right or left colectomy patients. Despite lack of change in BFI there is a sustained improvement in QoL following resection. Significantly worse baseline QoL and female urinary symptoms in the right colectomy cohort could be explained by advanced age and referral patterns of complex right sided neoplastic lesions to our tertiary care facility.