Abstract
Purpose
The deterioration of anorectal function after neoadjuvant chemoradiation therapy (nCRT) combined with surgery for rectal cancer has not been well defined. The aim of this study was to evaluate the relationship between the tumor response to nCRT and changes in anorectal function during a short-term period after nCRT.
Methods
We analyzed 100 consecutive patients with available preoperative anorectal manometry data, both before and after nCRT, from 2010 to 2013.
Results
Comparing the manometric data before and after nCRT, the values reflecting rectal sensory function after nCRT was significantly lower than those before nCRT. However, in patients who experienced changed tumor morphology and a reduction in luminal circumferential ratio (LCIR) of tumor after nCRT, the values reflecting rectal sensory function were significantly less decreased after nCRT. On multivariate analysis, the reduction of LCIR after nCRT was a very important factor preventing the impairment of anorectal function during the short-term period in terms of the first rectal sensory threshold (RST) (P = 0.002), the RST of “desire to defecate” (P = 0.006), and rectal compliance (P = 0.003). Additionally, in linear regression analysis, the RST for the desire to defecate was positively affected by tumor morphology (P = 0.015) and the reduced LCIR (P = 0.025), and rectal compliance was positively affected by the reduced LCIR (P = 0.001).
Conclusion
The nCRT impaired significantly rectal sensory function during the short-term period after nCRT and before a radical operation. However, this reduced LCIR of tumors after nCRT may prevent or minimize impediments to anorectal function during the short-term period after nCRT.
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References
Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740
Kapiteijn E, Marijnen CA, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646
Theodoropoulos G, Wise WE, Padmanabhan A et al (2002) T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival. Dis Colon Rectum 45:895–903
Dahlberg M, Glimelius B, Graf W, Påhlman L (1998) Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study. Dis Colon Rectum 41:543–549
Matzel KE, Bittorf B, Günther K et al (2003) Rectal resection with low anastomosis: functional outcome. Colorectal Dis 5:458–464
Iwamoto T, Nakahara S, Mibu R et al (1997) Effect of radiotherapy on anorectal function in patients with cervical cancer. Dis Colon Rectum 40:693–697
Yeoh E, Sun WM, Russo A et al (1996) A retrospective study of the effects of pelvic irradiation for gynecological cancer on anorectal function. Int J Radiat Oncol Biol Phys 35:1003–1010
Williams N, Seow-Choen F (1998) Physiological and functional outcome following ultra-low anterior resection with colon pouch-anal anastomosis. Br J Surg 85:1029–1035
Ammann K, Kirchmayr W, Klaus A et al (2003) Impact of neoadjuvant chemoradiation on anal sphincter function in patients with carcinoma of the midrectum and low rectum. Arch Surg 138:257–261
Bregendahl S, Emmertsen KJ, Fassov J et al (2013) Neorectal hyposensitivity after neoadjuvant therapy for rectal cancer. Radiother Oncol 108:331–336
Contin P, Kulu Y, Bruckner T et al (2014) Comparative analysis of late functional outcome following preoperative radiation therapy or chemoradiotherapy and surgery or surgery alone in rectal cancer. Int J Colorectal Dis 29:165–175
Birnbaum EH, Dreznik Z, Myerson RJ et al (1992) Early effect of external beam radiation therapy on the anal sphincter: a study using anal manometry and transrectal ultrasound. Dis Colon Rectum 35:757–761
Jang NY, Han TJ, Kang SB et al (2010) The short-term effect of neoadjuvant chemoradiation on anorectal function in low and midrectal cancer: analysis using preoperative manometric data. Dis Colon Rectum 53:445–449
Kye BH, Kim HJ, Kim JG et al (2013) Short-term effects of neoadjuvant chemoradiation therapy on anorectal function in rectal cancer patients: a pilot study. Radiat Oncol 8:203
Bregendahl S, Emmertsen KJ, Lous J, Laurberg S (2013) Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based cross-sectional study. Colorectal Dis 15:1130–1139
Schiessel R, Karner-Hanusch J, Herbst F et al (1994) Intersphincteric resection for low rectal tumours. Br J Surg 81:1376–1378
Rullier E, Laurent C, Bretagnol F et al (2005) Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg 241:465–469
Pahlman L, Bujko K, Rutkowski A, Michalski W (2013) Altering the therapeutic paradigm towards a distal bowel margin of <1 cm in patients with low-lying rectal cancer: a systematic review and commentary. Colorectal Dis 15:e166–e174
Bryant CL, Lunniss PJ, Knowles CH et al (2012) Anterior resection syndrome. Lancet Oncol 13:e403–e408
Lee TG, Kang SB, Heo SC et al (2011) Risk factors for persistent anal incontinence after restorative proctectomy in rectal cancer patients with anal incontinence: prospective cohort study. World J Surg 35:1918–1924
Palit S, Lunniss PJ, Scott SM (2012) The physiology of human defecation. Dig Dis Sci 57:1445–1464
Krol R, Smeenk RJ, van Lin EN et al (2014) Systematic review: anal and rectal changes after radiotherapy for prostate cancer. Int J Colorectal Dis 29:273–283
Yarnold J, Brotons MC (2010) Pathogenetic mechanisms in radiation fibrosis. Radiother Oncol 97:149–161
Krol R, Hopman WP, Smeenk RJ, Van Lin EN (2012) Increased rectal wall stiffness after prostate radiotherapy: relation with fecal urgency. Neurogastroenterol Motil 24:339–e166
Petersen SE, Bentzen L, Emmertsen KJ et al (2014) Development and validation of a scoring system for late anorectal side-effects in patients treated with radiotherapy for prostate cancer. Radiother Oncol 111:94–99
Varma JS, Smith AN, Busuttil A (1986) Function of the anal sphincters after chronic radiation injury. Gut 27:528–533
Varma JS, Smith AN, Busuttil A (1985) Correlation of clinical and manometric abnormalities of rectal function following chronic radiation injury. Br J Surg 72:875–878
Friedland S, Benaron D, Maxim P et al (2006) Absence of ischemia in telangiectasias of chronic radiation proctopathy. Endoscopy 38:488–492
Hanly AM, Ryan EM, Rogers AC et al (2014) Multicenter evaluation of rectal cancer reimaging post neoadjuvant (MERRION) therapy. Ann Surg 259:723–727
Martellucci J, Scheiterle M, Lorenzi B et al (2012) Accuracy of transrectal ultrasound after preoperative radiochemotherapy compared to computed tomography and magnetic resonance in locally advanced rectal cancer. Int J Colorectal Dis 27:967–973
Acknowledgments
We appreciate Nan Sook Lee and Bora Kang, who helped with data collection and performed the physiological studies.
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The authors declare that they have no conflict of interest.
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Kye, BH., Kim, HJ., Cho, HM. et al. Reduced luminal circumference of tumors plays a key role in anorectal function during the early period after neoadjuvant chemoradiation therapy in rectal cancer patients. Int J Colorectal Dis 30, 465–474 (2015). https://doi.org/10.1007/s00384-015-2155-4
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DOI: https://doi.org/10.1007/s00384-015-2155-4