Effect of Preoperative Radio(chemo)therapy on Long-term Functional Outcome in Rectal Cancer Patients: A Systematic Review and Meta-analysis |
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Authors: | Martin Loos MD Philipp Quentmeier MD Tibor Schuster PhD Ulrich Nitsche MD Ralf Gertler MD Andreas Keerl MD Thomas Kocher MD Helmut Friess MD Robert Rosenberg MD |
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Affiliation: | 1. Department of Surgery, Klinikum rechts der Isar, Technische Universit?t München, Munich, Germany 2. Institute of Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universit?t München, Munich, Germany 3. Department of Surgery, Kantonsspital Baden, Baden, Switzerland
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Abstract: | Background Preoperative radio(chemo)therapy (pR(C)T) significantly reduces the local recurrence risk and is therefore recommended in stage II/III rectal cancer. However, this multimodal treatment approach may be associated with late adverse effects. To determine the impact of pR(C)T on long-term anorectal, sexual, and urinary function, we performed a systematic review and meta-analysis. Methods PubMed, Embase, and the Cochrane Library were systematically searched for studies reporting on long-term functional outcome after rectal cancer resection with pR(C)T. Only studies that reported anorectal, sexual, and/or urinary function after rectal cancer resection in TME-technique with pR(C)T were eligible for inclusion. Results Twenty-five studies, including 6,548 patients, were identified. Methodological quality of the eligible studies was low. The majority of studies reported higher rates of anorectal (14/18 studies) and male sexual dysfunction (9/10 studies) after pR(C)T. Few studies examined female sexual dysfunction (n = 4). Meta-analysis revealed that stool incontinence occurred more often in irradiated patients (risk ratio (RR) = 1.67; 95 % confidence interval (CI), 1.36, 2.05; p < 0.0001) and manometric results were significantly worse after pR(C)T (mean resting pressures (weighted mean difference (WMD) = 15.04; 95 % CI, 0.77, 29.31; p = 0.04) and maximum squeeze pressures (WMD = 30.39; 95 % CI, 21.48, 39.3; p < 0.0001)). Meta-analysis of erectile dysfunction revealed no statistical significance (RR = 1.41; 95 % CI, 0.74, 2.72; p = 0.3). Six of eight studies and meta-analysis demonstrated no negative effect of pR(C)T on urinary function (RR = 1.05; 95 % CI, 0.67, 1.65; p = 0.82). Conclusions Although quality of studies on long-term functional outcome is limited, current evidence demonstrates that pR(C)T negatively affects anorectal function after TME. |
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