Preoperative Chemoradiation for Rectal Cancer Causes Prolonged Pudendal Nerve Terminal Motor Latency |
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Authors: | Jit F Lim MBBS FRCS Joe J Tjandra MD FRACS Richard Hiscock MBBS FANZCA Michael W T Chao MBBS FRANZCR Peter Gibbs MBBS FRACP |
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Institution: | (1) Department of Colorectal Surgery, Royal Melbourne and Epworth Hospitals, Parkville, Victoria, Australia;(2) Department of Colorectal Oncology, Epworth Hospital, Parkville, Victoria, Australia;(3) Private Medical Center, Royal Melbourne Hospital, Suites 15 and 16, Level 3, Royal Parade, Parkville, Victoria, 3050, Australia |
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Abstract: | Purpose A worsened anorectal function after chemoradiation for high-risk rectal cancer is often attributed to radiation damage of
the anorectum and pelvic floor. Its impact on pudendal nerve function is unclear. This prospective study evaluated the short-term
effect of preoperative combined chemoradiation on anorectal physiologic and pudendal nerve function.
Methods Sixty-six patients (39 men, 27 women) with localized resectable (T3, T4, or N1) rectal cancer were included in the study.
All patients received 45 Gy (1.8 Gy/day in 25 fractions) over five weeks, plus 5-fluorouracil (350 mg/m2/day) and leucovorin (20 mg/m2/day) concurrently on days 1 to 5 and 29 to 33. Patients who had rectal cancer with a distal margin within 6 cm of the anal
verge had the anus included in the field of radiotherapy (Group A, n = 26). Patients who had rectal cancer with a distal margin
6 to 12 cm from the anal verge had shielding of the anus during radiotherapy (Group B, n = 40). The Wexner continence score,
anorectal manometry and pudendal nerve terminal motor latency were assessed at baseline and four weeks after completion of
chemoradiation.
Results The median Wexner score deteriorated significantly (P < 0.0001) from 0 to 2.5 for both Groups A (range, 0–8) and B (range, 0–14). The maximum resting anal pressures were unchanged
after chemoradiation. The maximum squeeze anal pressures were reduced (mean = 166.5–157.5 mmHg) after chemoradiation. This
change was similar in both Groups A and B. Eighteen patients (Group A = 7, Group B = 11) developed prolonged pudendal nerve
terminal motor latency after chemoradiation. These 18 patients similarly had a worsened median Wexner continence score (range,
0–3) and maximum squeeze anal pressures (mean = 165.5–144 mmHg). The results obtained were independent of tumor response to
chemoradiation.
Conclusions Preoperative chemoradiation for rectal cancer carries a significant risk of pudendal neuropathy, which might contribute to
the incidence of fecal incontinence after restorative proctectomy for rectal cancer.
Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, April
30 to May 5, 2005. |
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Keywords: | Preoperative chemoradiation Pudendal neuropathy Fecal incontinence Rectal cancer |
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