Impact of intra-operative radiotherapy on evacuatory function following ultra-low anterior resection. A preliminary result of prospective randomized trial.
OBJECTIVE
Preoperative radiotherapy and/or chemotherapy have been reported as effective treatment for locally advanced low rectal carcinoma. However, recent follow-up studies represented severe postoperative evacuatory disorder, which annoys patients' quality of life.


METHODS
The present study was a part of a randomized trial protocol comparing between intraoperative radiotherapy with pelvic autonomic nerve preservation and control group without radiation. Of these, 24 patients having sphincter preservation were followed in terms of their bowel function with questionnaire and anorectal manometry.


RESULTS
In terms of background, patients' age, gender, depth of the tumor invasion and lymph node metastasis showed no significant difference between the groups. After stoma closure, frequency of bowel movement was increased and incontinence scores worsened in both groups. However, no significant difference was noted between the groups, postoperatively. Regarding anorectal manometry, postoperative anal sphincter tones were stable compared even to pre-operative findings and no difference was noted between the groups postoperatively. Anal canal length and sensory factor were stable and no difference between the groups. Volumetric factors such as rectal capacity and maximum tolerable volume were also stable even after ultra-low anterior resection.


CONCLUSIONS
Intraoperative radiotherapy did not affect adversely on evacuatory function following ultra-low anterior resection in the early postoperative period. Long-term follow-up is warranted.
Matsuoka
Hiroyoshi
H
Department of Surgery, Kyorin University, School of Medicine, Tokyo, Japan. hmatsu@ks.kyorin-u.ac.jp
Masaki
Tadahiko
T
Takayama
Makoto
M
Tonari
Ayako
A
Sato
Kazunori
K
Kobayashi
Takaaki
T
Sugiyama
Masanori
M
Atomi
Yutaka
Y
D003131:Combined Modality Therapy; D003672:Defecation; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000503:physiopathology / Q000628:therapy*; D012007:Rectum / Q000503:physiopathology