Effect of neoadjuvant chemoradiation on postoperative fecal continence and anal sphincter function in rectal cancer patients.
OBJECTIVE
Neoadjuvant chemoradiation (nCRT) followed by curative surgery has gained acceptance as the therapy of choice in locally advanced rectal cancer. This prospective study evaluates the effect of nCRT on postoperative anorectal function and continence.


METHODS
Group A consisted of 12 patients (59.8 +/- 11.9 years, male:female = 8:4) who received nCRT (5-FU, CPT-11. 45 + 5.4 Gy boost) before surgery and Group B of 27 patients (61.9 +/- 10.6 years, male:female = 16:11) who were treated by surgery alone. All patients received a questionnaire to evaluate stool continence and anorectal function before as well as after surgery. Anorectal function was further analyzed by perfusion manometry pre- and postoperatively.


RESULTS
Preoperatively, none of the patients had signs or symptoms of fecal incontinence, and preoperative measurements showed values within normal limits. Postoperatively, fecal continence was impaired in both groups, but no significant difference was found between patients with or without nCRT. Anorectal manometry revealed an impairment of anorectal function after low anterior resection regardless of the treatment regime.


CONCLUSIONS
nCRT does not impair anorectal function and fecal continence. The deterioration of continence and anal sphincter function after sphincter preserving surgery is solely caused by the surgical procedure.
Pietsch
Alexander P
AP
Department of Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany. alexander.pietsch@med.uni-rostock.de
Fietkau
Rainer
R
Klautke
Günther
G
Foitzik
Thomas
T
Klar
Ernst
E
D001003:Anal Canal / Q000503:physiopathology*; D017024:Chemotherapy, Adjuvant; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*