Skip to main content

Advertisement

SpringerLink
Log in

Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Deterioration of anorectal function after long-course preoperative chemoradiotherapy combined with surgery for rectal cancer is poorly defined. We conducted a prospective study to evaluate the acute and long term effects of preoperative chemoradiotherapy on anorectal function and quality of life of the patients.

Methods

There were 26 patients in surgery group and 31 patients in preoperative chemoradiotherapy group. Anorectal function and quality of life of the patients were assessed by anorectal manometry, incontinence score, quality of life questionnaire.

Results

Significant lower resting pressures in both groups and lower maximal squeeze pressures in the preoperative chemoradiotherapy group were observed after postsurgical evaluations compared with the paired pretreatment ones. In the surgery group, both the Wexner continence score, FIQL score, and the rectoscopy score were comparable before and after surgery, whereas significant worsening in the Wexner score was observed in the preoperative chemoradiotherapy group postoperatively (P < 0.01). Significant reduction in anal canal resting pressures and squeeze pressures, Wexner score, and FIQL score were observed immediately after the completion of preoperative chemoradiotherapy. Significant lower maximal squeeze pressures and worsening of the Wexner scores were observed in the preoperative chemoradiotherapy group compared to the surgery group during the postoperative assessments (P < 0.05 and P < 0.01, respectively).

Conclusions

Both total mesorectal excision and preoperative chemoradiotherapy may adversely affect the anorectal function. Careful selection of the patients who will benefit from neoadjuvant therapy and identifying the patients with a high risk of developing functional problems may help to improve functional outcomes for the treatment of rectal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740

    Article  CAS  PubMed  Google Scholar 

  2. Kapiteijn E, Marijnen CA, Nagtegaal ID et al, Dutch Colorectal Cancer Group (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646

    Article  CAS  PubMed  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. Wheeler JM, Dodds E, Warren BF et al (2004) Preoperative chemoradiotherapy and total mesorectal excision surgery for locally advanced rectal cancer: correlation with rectal cancer regression grade. Dis Colon Rectum 47:2025–2031

    Article  CAS  PubMed  Google Scholar 

  5. Terzi C, Canda AE, Sagol O et al (2008) Survivin, p53, and Ki-67 as predictors of histopathologic response in locally advanced rectal cancer treated with preoperative chemoradiotherapy. Int J Colorectal Dis 23:37–45

    Article  PubMed  Google Scholar 

  6. Lim JF, Tjandra JJ, Hiscock R, Chao MW, Gibbs P (2006) Preoperative chemoradiation for rectal cancer causes prolonged pudendal nerve terminal motor latency. Dis Colon Rectum 49:12–19

    Article  PubMed  Google Scholar 

  7. Frykholm GJ, Glimelius B, Påhlman L (1993) Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and an evaluation of late secondary effects. Dis Colon Rectum 36:564–572

    Article  CAS  PubMed  Google Scholar 

  8. Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36(1):77–97

    Article  CAS  PubMed  Google Scholar 

  9. Varma JS, Smith AN, Busuttil A (1985) Correlation of clinical and manometric abnormalities of rectal function following chronic radiation injury. Br J Surg 72(11):875–878

    Article  CAS  PubMed  Google Scholar 

  10. Rockwood TH, Church JM, Fleshman JW et al (2000) Fecal ıncontinence quality of life scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43:9–16

    Article  CAS  PubMed  Google Scholar 

  11. Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482

    Article  CAS  PubMed  Google Scholar 

  12. Wong RK, Tandan V, De Silva S, Figueredo A (2007) Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev 2:CD002102

    PubMed  Google Scholar 

  13. Minsky BD (1997) Adjuvant therapy for rectal cancer—a good first step. N Engl JMed 336:1016–1017

    Article  CAS  Google Scholar 

  14. Valentini V, Glimelius B, Minsky BD et al (2005) The multidisciplinary rectal cancer treatment: main convergences, controversial aspects and investigational areas which support the need for a European Consensus. Radiother Oncol 76:241–250

    Article  PubMed  Google Scholar 

  15. Pollack J, Holm T, Cedermark B, Holmström B, Mellgren A (2006) Long-term effect of preoperative radiation therapy on anorectal function. Dis Colon Rectum 49:345–352

    Article  PubMed  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. Da Silva GM, Berho M, Wexner SD et al (2003) Histologic analysis of the irradiated anal sphincter. Dis Colon Rectum 46:1492–1497

    Article  PubMed  Google Scholar 

  18. Lundby L, Jensen VJ, Overgaard J, Laurberg S (1997) Long-term colorectal function after postoperative radiotherapy for colorectal cancer. Lancet 350:564

    Article  CAS  PubMed  Google Scholar 

  19. Kusunoki M, Shoji Y, Yanagi H et al (1993) Anorectal function after preoperative intraluminal brachytherapy and colonic J pouch-anal anastomosis for rectal carcinoma. Br J Surg 80:933–935

    Article  CAS  PubMed  Google Scholar 

  20. 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

    Article  CAS  PubMed  Google Scholar 

  21. Murata A, Brown CJ, Raval M, Phang PT (2008) Impact of short-course radiotherapy and low anterior resection on quality of life and bowel function in primary rectal cancer. Am J Surg 195:611–615

    Article  PubMed  Google Scholar 

  22. Gervaz P, Rotholtz N, Pisano M et al (2001) Quantitative short-term study of anal sphincter function after chemoradiation for rectal cancer. Arch Surg 136(2):192–196

    Article  CAS  PubMed  Google Scholar 

  23. Pietsch AP, Fietkau R, Klautke G, Foitzik T, Klar E (2007) Effect of neoadjuvant chemoradiation on postoperative fecal continence and anal sphincter function in rectal cancer patients. Int J Colorectal Dis 22:1311–1317

    Article  PubMed  Google Scholar 

  24. Wagman R, Minsky BD, Cohen AM, Guillem JG, Paty PP (1998) Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: long term follow-up. Int J Radiat Oncol Biol Phys 42:51–57

    CAS  PubMed  Google Scholar 

  25. Tjandra JJ, Reading DM, McLachlan SA et al (2001) Phase II clinical trial of preoperative combined chemoradiation for T3 and T4 resectable rectal cancer: preliminary results. Dis Colon Rectum 44:1113–1122

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Dokuz Eylul University School of Medicine, 35340 Inciralti, Izmir, Turkey

    Aras Emre Canda, Cem Terzi, Selman Sokmen & Mehmet Fuzun

  2. Department of Radiation Oncology, Dokuz Eylul University School of Medicine, Izmir, Turkey

    Ilknur B. Gorken

  3. Department of Medical Oncology, Dokuz Eylul University School of Medicine, Izmir, Turkey

    Ilhan Oztop

Authors
  1. Aras Emre Canda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cem Terzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ilknur B. Gorken
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ilhan Oztop
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Selman Sokmen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mehmet Fuzun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aras Emre Canda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Canda, A.E., Terzi, C., Gorken, I.B. et al. Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients. Int J Colorectal Dis 25, 197–204 (2010). https://doi.org/10.1007/s00384-009-0807-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-009-0807-y

Keywords

Search

Navigation