[Influence of preoperative (hyperthermic) radiochemotherapy on manometric anal sphincter function in locally advanced rectal cancer].
OBJECTIVE
Preoperative radiochemotherapy (RCT) followed by curative surgery is a well-accepted therapeutic option in the treatment of advanced rectal cancer. Usually, the anal sphincter is located in the irradiation area of a preoperative RCT regime. The aim of this study is to evaluate the influence of preoperative RCT on anal sphincter function.


METHODS
Between 1994 and 2000, 102 patients with rectal cancer stage uT3/uT4 were analyzed. All patients underwent radiotherapy with 45 Gy (5 x 1.8 Gy) including two cycles of 5-fluorouracil (5-FU)/leucovorin (folinic acid) chemotherapy. 46 patients were treated additionally with up to five sessions of locoregional hyperthermia. The sphincter function was analyzed by perfusion manometry before preoperative therapy and 4 weeks after pretreatment had been finished. For statistics, the Wilcoxon signed rank test and Mann-Whitney U-test were used (SPSS 9.0 for Windows((R))).


RESULTS
The mean value of all 102 patients showed a significant reduction of the mean maximum resting pressure from 97 to 89 mmHg (p = 0.02). For the mean maximal squeeze pressure no significant difference could be shown (178 vs. 176 mmHg). For patients with distal (</= 7.5 cm from anal verge) tumors the difference was highly significant (92 vs. 79 mmHg). Locoregional hyperthermia had no additional influence on sphincter function.


CONCLUSIONS
Preoperative RCT impairs sphincter function especially in patients with distal tumors. In addition, RCT could have a negative influence on the continence of patients who received sphincter-preserving surgery.
Fritzmann
Johannes
J
Klinik für Chirurgie und Chirurgische Onkologie, Universitätsklinikum Charité, Humboldt-Universität zu Berlin, Robert-Rössle-Klinik im Helios-Klinikum Berlin, Berlin, Germany.
Hünerbein
Michael
M
Slisow
Wassilij
W
Gellermann
Johanna
J
Wust
Peter
P
Rau
Beate
B
D001003:Anal Canal / Q000187:drug effects / Q000503:physiopathology* / Q000528:radiation effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D007391:International Cooperation; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D016896:Treatment Outcome
D002955:Leucovorin; D005472:Fluorouracil