保留盆腔自主神经的全直肠系膜切除术对中、低位直肠癌患者术后排尿和性功能的影响

目的:探讨保留盆腔自主神经的全直肠系膜切除术后患者排尿及性功能的变化。方法:行保留盆腔自主神经(PANP)加全直肠系膜切除术(TME)的中、低位DukesB期的直肠癌患者38例作为研究组,同期行TME的DukesB期患者35例作为对照组。研究组中低位前切除(LAR)21例,经腹会阴联合切除(APR)17例;对照组中LAR20例,APR15例。观察并比较二组患者术前后排尿、性功能之变化。结果:研究组与对照组术后排尿功能障碍发生率分别为15.7%(6/38)与40%(14/35)(P=0.013);研究组LAR与APR组性功能障碍发生率分别为9.5%(2/21)、29.4%(5/17),总的性功能障碍率为18.4%(7/38);对照组中分别为35%(7/20)、73.3%(11/15)和51.4%(18/35),研究组性功能障碍发生率明显低于对照组(P=0.002)。结论:Dukes B期患者行保留盆自主神经的全直肠系膜切除术能明显降低术后排尿、性功能障碍的发生率,提高患者术后生活质量。     

直肠癌TME术中保留盆腔自主神经对男性性功能及排尿功能的影响

目的探讨直肠全系膜切除术(TME)中保留盆腔自主神经(PANP)对术后男性患者性功能及排尿功能的影响。方法回顾性分析我院2008年1月至2010年10月期间行直肠癌根治术的84例患者临床资料,根据不同的手术方式分为PANP+TME组(n=41)和TME组(n=43),对2组患者术后排尿及性功能障碍发生率和局部复发率情况进行比较。结果 PANP+TME组与TME组患者术后勃起功能障碍发生率分别为29.3%(12/41)和76.7%(33/43),射精功能障碍发生率为26.8%(11/41)和79.1%(34/43),排尿障碍发生率分别为24.4%(10/41)和79.1%(34/43),2组间差异均有统计学意义(P<0.05)。PANP+TME组和TME组术后局部复发率分别为9.8%(4/41)和11.6%(5/43),2组比较差异无统计学意义(P>0.05)。结论直肠癌在TME基础上行PANP可以降低男性患者术后排尿和性功能障碍的发生率,且并不增加术后肿瘤局部复发率。     

Recurrence and survival after mesorectal excision for rectal cancer

BACKGROUND: Mesorectal excision for rectal cancer has resulted in local recurrence rates of 3-11 per cent compared with up to 38 per cent after conventional methods. The results of a prospective Danish study with a historical control group are presented. METHODS: Three hundred and eleven patients with a mobile rectal cancer had mesorectal excision with curative intent performed by certified surgeons and were followed for 3 years. Demographic, perioperative and follow-up data were recorded prospectively. A series of patients who had conventional operations for rectal cancer served as a control group. RESULTS: The cumulative 3-year local recurrence rate was 11 per cent after mesorectal excision compared with 30 per cent after conventional surgery (hazard ratio (HR) 0.33 (95 per cent confidence interval (c.i.) 0.21 to 0.52); P < 0.001). Multivariate regression analysis showed that only advanced age (HR 0.97 (95 per cent c.i. 0.94 to 1.00); P = 0.048) and tumour in the lower third of the rectum (HR 0.21 (95 per cent c.i. 0.04 to 1.97); P = 0.075) were marginal independent predictors of local recurrence after mesorectal excision. The cumulative crude 3-year survival rate was 77 per cent after mesorectal excision and 62 per cent after conventional surgery (HR 0.58 (95 per cent c.i. 0.43 to 0.77); P < 0.001). Age was the only independent predictor of death after mesorectal excision (HR 1.04 (95 per cent c.i. 1.02 to 1.07); P = 0.001). CONCLUSION: Mesorectal excision is associated with a considerably lower risk of local recurrence and a better survival rate than conventional surgery, and is the optimum method for rectal cancer resection.     

全直肠系膜切除并自主神经保留术治疗直肠癌的疗效评价

目的评价全直肠系膜切除（TME）并保留盆腔自主神经（PANP）的直肠癌根治术对直肠癌患者术后性功能、复发和生存期的影响。方法回顾性分析1997年10月至2004年6月共105例行TME并保留自主神经的男性直肠癌患者（保留自主神经组）术后的随访资料,并与同期110例TME不保留自主神经的男性直肠癌患者（不保留自主神经组）术后的性功能、复发和生存率进行比较。结果勃起障碍保留自主神经组33．3％（35／105）,不保留自主神经组63．2％（68／110）,两组比较差异具有统计学意义（X^2=17．466,P〈0．001）。射精障碍保留自主神经组43．8％（46／105）,不保留自主神经组70．0％（77／110）,两组比较差异具有统计学意义（x。=15．053,P〈0．001）。保留自主神经组局部复发率7．6％（8／105）,不保留自主神经组局部复发率5．5％（6／110）,两组差异无统计学意义（X^2=0．413,P=0．520）。5年生存率保留自主神经组为63．4％,不保留自主神经组为59．7％（P〉0．05）。结论TME并PANP的直肠癌根治术既能保证手术根治,同时术后性功能障碍率低,生存质量提高。     

Optimal preoperative assessment and surgery for rectal cancer may greatly limit the need for radiotherapy

BACKGROUND: Radiation is being used increasingly in the management of patients with rectal cancer. Over the past decade the Basingstoke Colorectal Research Unit has combined precision total mesorectal excision with the highly selective use of preoperative radiotherapy. METHODS: One hundred and fifty consecutive patients who underwent major surgical excision for cancers of all stages comprised the study group. Preoperative clinical assessment was based largely on tumour size, fixation and distance from the anal verge. Only preoperative radiotherapy was considered and this only for tumours judged to be at high risk of mesorectal fascia involvement. RESULTS: During a 5-year period 35 of 150 patients were selected for preoperative irradiation. In the non-irradiated patients the local recurrence rate after a median follow-up period of 870 (range 51-1903) days was 2.6 per cent (three of 115 patients), compared with 17.1 per cent (six of 35 patients) in those chosen for irradiation. Sixty patients (52.2 per cent) who were not irradiated were node positive. The local recurrence rate for the whole group was 6.0 per cent. CONCLUSION: The great majority of patients undergoing major excision for rectal cancer can be managed without radiation therapy if the preoperative assessment of the mesorectal fascia and surgery are performed optimally.     

保留盆腔植物神经对老年男性患者术后性功能及排尿功能的影响

目的:探讨保留盆腔植物神经的直肠癌手术对老年男性患者性功能及排尿功能的影响。方法:1999~2005年因直肠癌手术的170例老年男性患者分为PANP组(含规范的TME手术方法)和非PANP(TME规范情况不详),对两组术后性功能、排尿功能和局部复发率进行回顾性总结、比较。结果:PANP组性功能与排尿功能明显优于非PANP组,但统计学无显著差异(P<0.05)。而PANP组局部复发率低于非PANP组(P>0.05)。结论:老年直肠癌患者应重视性功能和排尿功能的保护。     

Total mesorectal excision preserves male genital function compared with conventional rectal cancer surgery.

BACKGROUND: The introduction of total mesorectal excision (TME) has been shown to improve local recurrence rates in rectal cancer. The present study investigated the impact of this more extensive and radical procedure with regard to autonomic pelvic nerve function. METHODS: Patients with resected primary rectal cancer were interviewed by means of a questionnaire asking about preoperative and postoperative urinary bladder and genital function. The results in patients after rectal cancer surgery without TME (group 1; n = 29) were compared with those obtained after introduction of the TME technique (group 2; n = 31). Patients in group 2 were older and had a lower level of anastomosis than patients in group 1. Other patient, treatment and tumour characteristics were comparable between the groups. RESULTS: : Newly acquired and permanent symptoms of bladder dysfunction after rectal excision were present as follows (group 1 versus group 2): difficulty in bladder emptying 7 versus 19 per cent; sensation of incomplete bladder voiding 17 versus 17 per cent; urgency 17 versus 14 per cent; incontinence 10 versus 3 per cent; dysuria 7 versus 7 per cent; and dribbling 14 versus 8 per cent. Male patients stated the following sexual functions before operation/after operation in group 1 versus group 2: interest in sex 80 per cent/40 per cent versus 63 per cent/37 per cent; sexually active 67 per cent/7 per cent versus 53 per cent/22 per cent; impotence 75 per cent/6 per cent versus 58 per cent/26 per cent; ability to have intercourse 75 per cent/13 per cent versus 67 per cent/29 per cent; ability to achieve orgasm 88 per cent/13 per cent versus 76 per cent/47 per cent; and orgasm with ejaculation 88 per cent/9 per cent versus 76 per cent/53 per cent. CONCLUSION: While both conventional rectal cancer surgery and TME result in similarly favourable postoperative bladder function, both techniques decrease sexual function. However, TME offers a significant advantage with regard to preservation of postoperative sexual function in men and constitutes a true advance in rectal cancer surgery compared with conventional techniques.     

Residual urine volume after total mesorectal excision: an indicator of pelvic autonomic nerve preservation? Results of a case‐control study

OBJECTIVE: The rate of bladder dysfunctions after total mesorectal excision (TME) for rectal cancer can be decreased by bilateral pelvic autonomic nerve preservation (PANP). However, it is not clear yet, how often partial nerve impairment may lead to bladder dysfunction. It was the aim of a case-control study, to examine the residual urine volume in patients before and after TME with and without complete PANP, in order to clarify, whether this parameter allows conclusions on the quality of PANP. PATIENTS AND METHODS: Regarding bladder function, a case group (n = 26) without complete PANP was compared with a control group (n = 26) with complete identification and nerve preservation according to standadized intra-operative documentation. Twenty-six match pairs were established, identical regarding gender, wall infiltration depth, tumour site, operation procedure and operation extent. Rates of neoadjuvant therapy, R0-classification, anastomotic leakage, wound and urinary tract infection were equally distributed for both the case- and control group (P > 0.05). Residual urine volume was pre- and post-operatively determined by sonography. RESULTS: Pre-operatively, residual urine volumes differed neither between the pairs nor between both groups with and without nerve preservation. In the case group with incomplete PANP there was a difference between pre- and post-operative residual urine volume (median; quartil: 2.5 ml; 0.0-32.5 ml vs 130 ml; 0.0-317 ml; P = 0.001). In the control group there was no difference (median; quartile: 0.0 ml; 0.0-20 ml vs 15.5 ml; 0.0-62.0 ml; P = 0.07). The difference between the postoperatively measured volumes of the case and control group were significant (P = 0.001). With residual urine volume = 100 ml, the risk of incomplete PANP was 14 times higher (odds ratio). CONCLUSIONS: Residual urine volume is an indicator of the completeness of PANP during TME. It should be determined pre- and post-operatively, and besides the recording of the neurogenic bladder, serve as a quality control.     

腹腔镜辅助直肠癌根治术对盆腔自主神经保护的操作要点

目的 探讨腹腔镜辅助保留盆腔自主神经直肠癌根治术的临床疗效.方法 2011年3月至2013年3月经病理确诊的149例病人进行保留自主神经的直肠癌根治术,其中腹腔镜组84例,开腹组65例.术后1年内通过门诊和问卷方式观察两组病人术后排尿功能与性功能状况.结果 术后排尿功能障碍发生率,腹腔镜组和开腹组分别为18.57％、21.82％,两组比较差异无统计学意义（P＞0.05）.术后勃起功能障碍发生率,腹腔镜组和开腹组分别为47.14％、43.64％,射精功能障碍发生率分别为34.29％ 、32.13％,两组比较差异无统计学意义（P＞0.05）.结论 腹腔镜辅助保留盆腔自主神经的直肠癌根治术是安全、有效的.     

Impact of a surgical training programme on rectal cancer outcomes in Stockholm

BACKGROUND: Total mesorectal excision (TME) and use of adjuvant radiotherapy are major advances in the treatment of rectal cancer that have emerged in the past 20 years. The aim of this study was to evaluate the effects of an initiative to teach the TME technique on outcomes at 5 years after surgery. METHODS: TME-based surgery was introduced in Stockholm in 1994. The study population comprised all 447 patients who underwent abdominal operations for rectal cancer in Stockholm County during 1995 and 1996. Outcomes were compared with those in the Stockholm I (790 patients) and Stockholm II (542 patients) radiotherapy trials. RESULTS: The permanent stoma rate was reduced from 60.3 and 55.3 per cent in the Stockholm I and II trials respectively to 26.5 per cent in the TME project (P < 0.001). Five-year local recurrence rates decreased from 21.9 and 19.1 per cent to 8.2 per cent respectively (P < 0.001). Five-year cancer-specific survival rates increased from 66.0 and 65.7 per cent in the Stockholm trials to 77.3 per cent in the TME project (hazard ratio 0.62 (95 per cent confidence interval 0.49 to 0.80); P < 0.001). CONCLUSION: A surgical teaching programme had a major impact on rectal cancer outcome.     

Male urogenital function after confirmed nerve-sparing total mesorectal excision with dissection in front of Denonvilliers' fascia

This prospective study addresses the rate of male genital dysfunction following total mesorectal excision (TME) for rectal carcinoma using the anterior extramesorectal plane and its correlation with early urinary function, pelvic autonomic nerve preservation (PANP), and intraoperative neurostimulation (INS). A consecutive series of 44 men operated on by the same surgical team was analyzed. After excluding 18 patients considered to be impotent preoperatively, urogenital function was evaluated in 26 patients on the basis of the International Prostatic Symptom Score and International Index of Erectile Function. PANP was assessed with INS of parasympathetic nerves. PANP was complete in 21 patients (80.8%). Deterioration of urinary function was observed in six patients (23.1%) at early follow-up. Postoperative erectile dysfunction assessed in seven patients (26.9%) was associated with micturition disturbances in four (57%). Despite dissection in front of Denonvilliers fascia, the incidence of erectile dysfunction was low in patients with nonanterior tumors (1/10). INS results had higher sensitivity for predicting urinary dysfunction than for predicting erectile dysfunction (67% vs. 43%). Values for specificity and accuracy were 95% and 90%, and 89% and 77%, respectively. The correlation between the findings on INS and urinary function was good (kappa = 0.66) at a fair (kappa = 0.36) correlation for erectile function. Nerve-sparing TME using the anterior extramesorectal plane results in a justifiable rate of postoperative impotence in patients with nonanterior tumors. Patients with negative results on INS or early urinary dysfunction are at greater risk of erectile dysfunction.     

The long-term voiding function and sexual function after pelvic nerve-sparing radical surgery for rectal cancer

BACKGROUND: The aim of the present study is to symptomatically analyze the extent to which pelvic nerve-sparing radical surgery for rectal cancer impacts on long-term voiding and male sexual function. METHODS: A self-administered questionnaire was mailed to 68 patients who underwent pelvic nerve-sparing radical surgery for invasive rectal cancer with 52 responses (28 men and 24 women; 27 complete and 25 incomplete preservation; response rate 76.5%). Each patient was asked to record if there had been any changes in lower urinary tract symptoms after surgery. Sexual function was also investigated in men. RESULTS: Of the 52 patients, 48 (92%) maintained voluntary voiding without catheterization in the long term. Clean intermittent self-catheterization was performed in only four patients with incomplete preservation because of persistent voiding dysfunction. Subjectively, approximately 60% of the patients remained unchanged in lower urinary tract symptoms after surgery. The satisfaction rate regarding the current voiding status was significantly higher in women than in men (83% versus 61%, P = 0.0294), but was not significantly different between those with complete (76%) and incomplete preservation (64%). Despite the acceptable urinary status, 88% of men had some deterioration in the erectile function, regardless of the types of surgical procedures. Overall, 64% of men were unsatisfied with the current sexual function. CONCLUSIONS: Pelvic nerve-sparing radical surgery for rectal cancer preserved the long-term voiding function in the majority of patients. In completely preserved patients and in women, symptomatic outcomes were more satisfactory. Postoperative erectile dysfunction was found to be a serious problem, even in complete nerve-sparing procedure.     

Male Urogenital Function After Confirmed Nerve-Sparing Total Mesorectal Excision with Dissection in Front of Denonvilliers’ Fascia

This prospective study addresses the rate of male genital dysfunction following total mesorectal excision (TME) for rectal carcinoma using the anterior extramesorectal plane and its correlation with early urinary function, pelvic autonomic nerve preservation (PANP), and intraoperative neurostimulation (INS). A consecutive series of 44 men operated on by the same surgical team was analyzed. After excluding 18 patients considered to be impotent preoperatively, urogenital function was evaluated in 26 patients on the basis of the International Prostatic Symptom Score and International Index of Erectile Function. PANP was assessed with INS of parasympathetic nerves. PANP was complete in 21 patients (80.8%). Deterioration of urinary function was observed in six patients (23.1%) at early follow-up. Postoperative erectile dysfunction assessed in seven patients (26.9%) was associated with micturition disturbances in four (57%). Despite dissection in front of Denonvilliers′ fascia, the incidence of erectile dysfunction was low in patients with nonanterior tumors (1/10). INS results had higher sensitivity for predicting urinary dysfunction than for predicting erectile dysfunction (67% vs. 43%). Values for specificity and accuracy were 95% and 90%, and 89% and 77%, respectively. The correlation between the findings on INS and urinary function was good (κ = 0.66) at a fair (κ = 0.36) correlation for erectile function. Nerve-sparing TME using the anterior extramesorectal plane results in a justifiable rate of postoperative impotence in patients with nonanterior tumors. Patients with negative results on INS or early urinary dysfunction are at greater risk of erectile dysfunction.     

实时神经监测在腹腔镜直肠癌全直肠系膜切除术中盆腔自主神经丛保护的应用

目的 探讨实时神经监测在腹腔镜直肠癌全直肠系膜切除术中盆腔自主神经丛保护的应用。方法 选取2017年1月至2020年12月非急诊收治的直肠癌患者,共11例。所有患者均进行腹腔镜直肠癌全直肠系膜切除术,术中使用实时神经监测进行盆腔自主神经丛保护,术后评估排尿、肛管直肠功能,并分析两者相关性。结果 所有患者均成功进行术中实时神经监测,神经监测电生理结果均为阳性,术后第6月进行功能评估,均未发生排尿、肛管直肠功能不全,两者相关性良好（r=1.0）。结论 实时神经监测在腹腔镜直肠癌全直肠系膜切除术中盆腔自主神经丛保护的应用安全、有效,结果阳性提示术后排尿、肛管直肠功能完好。     

Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique

BACKGROUND: Bladder and sexual dysfunction are recognized complications of mesorectal resection. Their incidence following laparoscopic surgery is unknown. METHODS: Bladder and sexual function were assessed in patients who had undergone laparoscopic rectal, open rectal or laparoscopic colonic resection as part of the UK Medical Research Council Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer (CLASICC) trial, using the International Prostatic Symptom Score, the International Index of Erectile Function and the Female Sexual Function Index. Sexual and bladder function data from the European Organization for Research and Treatment of Cancer QLQ-CR38 collected in the CLASICC trial were used for comparison. RESULTS: Two hundred and forty-seven (71.2 per cent) of 347 patients completed questionnaires. Bladder function was similar after laparoscopic and open rectal operations for rectal cancer. Overall sexual function and erectile function tended to be worse in men after laparoscopic rectal surgery than after open rectal surgery (overall function: difference - 11.18 (95 per cent confidence interval (c.i.) -22.99 to 0.63), P = 0.063; erectile function: difference -5.84 (95 per cent c.i. -10.94 to -0.74), P = 0.068). Total mesorectal excision (TME) was more commonly performed in the laparoscopic rectal group than in the open rectal group. TME (odds ratio (OR) 6.38, P = 0.054) and conversion to open operation (OR 2.86, P = 0.041) were independent predictors of postoperative male sexual dysfunction. No differences were detected in female sexual function. CONCLUSION: Laparoscopic rectal resection did not adversely affect bladder function, but there was a trend towards worse male sexual function. This may be explained by the higher rate of TME in the laparoscopic rectal resection group.     

Impact of radiotherapy on local recurrence of rectal cancer in Norway

BACKGROUND: The purpose of this study was to analyse the impact of radiotherapy on local recurrence of rectal cancer in Norway after the national implementation of total mesorectal excision (TME). METHODS: This was a prospective national cohort study of 4113 patients undergoing major resection of rectal carcinoma between November 1993 and December 2001. RESULTS: The proportion of patients who had radiotherapy before or after operation increased from 4.6 per cent in 1994 to 23.0 per cent in 2001. The cumulative 5-year local recurrence rate decreased from 16.2 to 10.7 per cent. Multivariable analysis showed that preoperative radiotherapy significantly reduced local recurrence (hazard ratio 0.59 (95 per cent confidence interval 0.39 to 0.87)). The use of preoperative radiotherapy in patients from a local hospital offering radiotherapy was 50 per cent higher than that for patients from a hospital without such services (P = 0.003); cumulative 5-year local recurrence rates for these patients were 10.6 and 15.8 per cent respectively (P < 0.001). CONCLUSION: Following national implementation of TME for rectal cancer, increased use of preoperative radiotherapy appeared to reduce recurrence rates further.     

直肠癌全系膜切除术中保留自主神经的临床效果分析

目的探讨直肠癌全系膜切除术(total mesorectal excision,TME)中保留自主神经和保肛手术的临床效果。方法回顾性分析1999年1月至2005年12月收治的160例男性中低位直肠癌患者的临床资料,随机分成2组:A组86例,行TME并保留自主神经;B组74例,行TME,不保留自主神经,比较两组的性功能、局部复发率和生存率。结果A、B组术后排尿功能障碍率分别为12.8%和59.5%,性功能障碍率分别为66.3%和93.2%,两组比较有统计学差异(P<0.01)。A、B组术后局部复发率、5年生存率及吻合口瘘的发生率分别为8.1%vs.6.8%,61.6%vs.59.5%,8.1%vs.8.1%,两组比较差异无统计学意义(P>0.05)。结论在直肠癌TME的基础上保留自主神经,既保证了手术根治,局部复发率不增加,同时降低病人术后性功能障碍和排尿功能障碍发生率,可提高病人的生存质量。     

Bladder and sexual dysfunction after mesorectal excision for rectal cancer

BACKGROUND: Urinary and sexual dysfunction are recognized complications of rectal excision for cancer. The aim of this study was to examine the frequency of such complications after mesorectal excision, shortly after this method was introduced. METHODS: Spontaneous flowmetry, residual volume of urine measurement and urodynamic examination, including cystometry and simultaneous detrusor pressure and urinary flow recording, was carried out before and 3 months after curative rectal excision. Urinary symptoms and sexual function were evaluated by means of questionnaires before and after operation. Each patient served as his or her own control. RESULTS: Forty-nine consecutive patients, 39 of whom had a total mesorectal excision (TME) and ten a partial mesorectal excision, were examined before surgery and 35 again after operation. In two patients, a weak detrusor was detected before operation. Two patients developed signs of bladder denervation after operation. Transitory moderate urinary incontinence appeared in four other women. Six of 24 men reported some reduction in erectile function and one became impotent. Two men reported retrograde ejaculation. All the complications were seen in the TME group. CONCLUSION: Mesorectal excision for rectal cancer resulted in a low frequency of serious bladder and sexual dysfunction.     

Impact of total mesorectal excision on the results of surgery of distal rectal cancer.

BACKGROUND: This study reviewed the results of surgery for distal rectal cancer (tumours within 6 cm of the anal verge) following the introduction of total mesorectal excision for rectal cancer in one institution. METHODS: Two hundred and five patients who had undergone surgical resection of rectal cancer within 6 cm of the anal verge were included. The demographic, operative and follow-up data were collected prospectively. Comparisons were made between patients who had different surgical procedures. RESULTS: Abdominoperineal resection (APR) was performed in 27.8 per cent of patients, falling from 36.0 per cent in the first 3 years to 20.0 per cent in the last 3 years of the study. The overall operative mortality rate was 1.5 per cent and the morbidity rate 30.2 per cent. With a mean follow-up of 36 months, local recurrence occurred in 28 of the 185 patients who had curative resection. The 5-year actuarial local recurrence rates for double-stapled anastomosis, peranal coloanal anastomosis and APR were 11.2, 34.6 and 23.5 per cent respectively. The local recurrence rate was significantly lower for double-stapled low anterior resection than for the other types of operation. The overall 5-year survival rate in patients with low anterior resection and APR was 69.1 and 51.1 per cent respectively (P = 0.12). CONCLUSION: With the practice of total mesorectal excision, APR was necessary in only 27.8 per cent of patients with rectal cancer within 6 cm of the anal verge. The local recurrence rate was much lower in patients with double-stapled low anterior resection than in those treated with APR or peranal anastomosis.     

Late adverse effects of short-course preoperative radiotherapy in rectal cancer

BACKGROUND: Preoperative radiotherapy improves local control and survival in rectal cancer, but there are few reports on long-term morbidity. The aims of this study were to compare long-term morbidity and quality of life in patients undergoing rectal cancer surgery with or without preoperative radiotherapy. METHODS: A total of 252 patients, randomized within the two Stockholm trials on preoperative radiotherapy in rectal cancer, were alive at a mean of 15 years after surgery. Some 139 of these patients were available for follow-up by questionnaires and clinical examination. Questionnaires regarding medical history and quality of life were completed by all patients. All patients had a clinical examination, and those without a stoma underwent rigid sigmoidoscopy. RESULTS: Overall, patients who had preoperative radiotherapy experienced significantly more late complications than those who did not (69 versus 43 per cent; P = 0.002). This morbidity consisted mainly of cardiovascular disease (35 versus 19 per cent; P = 0.032), faecal incontinence (12 of 21 versus 11 of 42 patients having anterior resection; P = 0.013) and urinary incontinence (45 versus 27 per cent; P = 0.023). No significant differences between groups were found for hip or pelvic fractures, small bowel obstruction or global quality of life. CONCLUSION: Preoperative short-course, high-dose radiotherapy in patients with rectal cancer increases the risk of anal and urinary dysfunction, and may lead to increased cardiovascular morbidity, at long-term follow-up.