Effect of neoadjuvant chemoradiation on postoperative fecal continence and anal sphincter function in rectal cancer patients |
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Authors: | Alexander P Pietsch Rainer Fietkau Günther Klautke Thomas Foitzik Ernst Klar |
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Institution: | (1) Department of Surgery, University of Rostock, Schillingallee 35, 18057 Rostock, Germany;(2) Department of Radiation Oncology, University of Rostock, Rostock, Germany;(3) Department of General, Thoracic, Vascular, and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057 Rostock, Germany |
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Abstract: | Background and aims Neoadjuvant chemoradiation (nCRT) followed by curative surgery has gained acceptance as the therapy of choice in locally advanced
rectal cancer. This prospective study evaluates the effect of nCRT on postoperative anorectal function and continence.
Patients and methods Group A consisted of 12 patients (59.8 ± 11.9 years, male:female = 8:4) who received nCRT (5-FU, CPT-11. 45 + 5.4 Gy boost)
before surgery and Group B of 27 patients (61.9 ± 10.6 years, male:female = 16:11) who were treated by surgery alone. All
patients received a questionnaire to evaluate stool continence and anorectal function before as well as after surgery. Anorectal
function was further analyzed by perfusion manometry pre- and postoperatively.
Results Preoperatively, none of the patients had signs or symptoms of fecal incontinence, and preoperative measurements showed values
within normal limits. Postoperatively, fecal continence was impaired in both groups, but no significant difference was found
between patients with or without nCRT. Anorectal manometry revealed an impairment of anorectal function after low anterior
resection regardless of the treatment regime.
Conclusion nCRT does not impair anorectal function and fecal continence. The deterioration of continence and anal sphincter function
after sphincter preserving surgery is solely caused by the surgical procedure. |
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Keywords: | Neoadjuvant chemoradiation Rectal cancer Fecal incontinence Manometry |
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