Rectal cancer in the elderly: patients' perception of bowel control after restorative surgery

The risk of incontinence is perceived as a relative contraindication to a sphincter-saving procedure in elderly patients with rectal cancer. To investigate this, we reviewed functional results one year after restorative surgery in patients older than aged 75 years.

A total of 186 patients older than aged 75 years were diagnosed with rectal cancer during the study period. In 19 patients, no surgery was undertaken, and another 3 patients had a defunctioning stoma only. A local excision was performed in six patients. Of the remaining 158 having a major resection, 133 patients (84 percent) had a restorative anterior resection. The one-year, follow-up records of these patients were studied with particular reference to the patients' perception of bowel function and continence.

At one year, 99 patients who had had an anterior resection were alive. In 92 patients, a stoma had been closed or avoided altogether, and these patients formed the study group. Significant problems with bowel function or continence were denied by 78 of 92 patients (85 percent). One patient had already reported severe difficulties and been given a definitive stoma for incontinence. The remaining 14 percent, although experiencing some problems with continence, did not consider the situation serious enough to contemplate a stoma.

An elderly patient undergoing anterior resection for rectal cancer has a reasonable expectation of acceptable continence. Age alone should not be a contraindication to a restorative resection.