title: Anorectal and sexual functions after preoperative radiotherapy and full-thickness local excision of rectal cancer.
abstract: OBJECTIVE
  Local excision with preoperative radiotherapy may be considered as alternative management to abdominal surgery alone for small cT2-3N0 tumours. However, little is known about anorectal and sexual functions after local excision with preoperative radiotherapy. Evaluation of this issue was a secondary aim of our previously published prospective multicentre study.
  
  
  METHODS
  Functional evaluation was based on a questionnaire completed by 44 of 64 eligible disease-free patients treated with preoperative radiotherapy and local excision. Additionally, ex post, these results were confronted with those recorded retrospectively in the control group treated with anterior resection alone (N = 38).
  
  
  RESULTS
  In the preoperative radiotherapy and local excision group, the median number of bowel movements was two per day, incontinence of flatus occurred in 51% of patients, incontinence of loose stool in 46%, clustering of stools in 59%, and urgency in 49%; these symptoms occurred often or very often in 11%-21% of patients. Thirty-eight per cent of patients claimed that their quality of life was affected by anorectal dysfunction. Nineteen per cent of men and 20% of women claimed that the treatment negatively influenced their sexual life. The anorectal functions in the preoperative radiotherapy and local excision group were not much different from that observed in the anterior resection alone group.
  
  
  CONCLUSIONS
  Our study suggests that anorectal functions after preoperative radiotherapy and local excision may be worse than expected and not much different from that recorded after anterior resection alone. It is possible that radiotherapy compromises the functional effects achieved by local excision.
authors: Department of Surgery, Praski Hospital, Warsaw, Poland.
authors: A
authors: A
authors: Gornicki
authors: Department of Surgery, Jagiellonian Medical University College, Krakow, Poland.
authors: P
authors: P
authors: Richter
authors: Department of Surgical Oncology, Medical University, Lublin, Poland.
authors: W
authors: W
authors: Polkowski
authors: Department of Rehabilitation, Jozef Pilsudski University of Physical Education, Warsaw, Poland.
authors: M
authors: M
authors: Szczepkowski
authors: Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland.
authors: L
authors: L
authors: Pietrzak
authors: Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland.
authors: L
authors: L
authors: Kepka
authors: Surgical Division of Department of Gastrointestinal Oncology, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland.
authors: A
authors: A
authors: Rutkowski
authors: Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland. Electronic address: bujko@coi.waw.pl.
authors: K
authors: K
authors: Bujko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology*; D003131:Combined Modality Therapy; D003672:Defecation / Q000502:physiology; D005242:Fecal Incontinence / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D020127:Recovery of Function / Q000502:physiology; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012007:Rectum / Q000503:physiopathology*; D012189:Retrospective Studies; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Anorectal function; Local excision; Rectal cancer