title: Manometric evaluation of anorectal function in patients treated with neoadjuvant chemoradiotherapy and total mesorectal excision for rectal cancer.
abstract: BACKGROUND
  An altered anorectal function is reported after chemoradiotherapy (CRT) and surgery for rectal cancer.
  
  
  OBJECTIVE
  The aim of this study was to clarify the relative contribution of neoadjuvant chemoradiation and surgical resection on the impairment of anorectal function as evaluated by anorectal manometry.
  
  
  METHODS
  Thirty-nine patients with rectal cancer, who underwent neoadjuvant CRT and laparoscopic rectal resection, were evaluated with the Pescatori Faecal Incontinence score, and with anorectal manometry: before neoadjuvant therapy (T0), after neoadjuvant therapy and before surgery (T1), 12 months after stoma closure (T2).
  
  
  RESULTS
  Resting and/or maximum squeeze pressure and/or volume thresholds for urgency were below the normal values in 12 (30%) patients at baseline. After CRT the mean resting pressure significantly decreased (p=0.007). Surgery determined a significantly decrease of the resting pressure (p=0.001), of the maximum squeeze pressure (p=0.001) and of the volume threshold for urgency (p=0.001). Impairment of continence was reported by 5, 11 and 18 patients at T0, T1 and T2, with a mean incontinence score of 3, 3.8 and 3.9 respectively.
  
  
  CONCLUSIONS
  CRT is detrimental to the function of the internal anal sphincter. Rectal resection significantly affects both internal and external anal sphincter function and the maximum tolerated volume of the neo-rectum, particularly in patients with low rectal cancer, significantly impairing anal continence.
authors.affiliation: Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy. Electronic address: denardi.paola@hsr.it.
authors.forename: Paola
authors.initials: P
authors.lastname: De Nardi
authors.affiliation: Gastroenterology Division, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Sabrina Gloria Giulia
authors.initials: SG
authors.lastname: Testoni
authors.affiliation: National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK.
authors.forename: Maura
authors.initials: M
authors.lastname: Corsetti
authors.affiliation: Service de Anesthésiologie,Etablissements Hospitaliers du Nord Vaudois, Yverdon-les-Bain, Switzerland.
authors.forename: Hulda
authors.initials: H
authors.lastname: Andreoletti
authors.affiliation: Gastroenterology Division, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Giollo
authors.affiliation: Gastroenterology Division, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Passaretti
authors.affiliation: Gastroenterology Division, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Pier Alberto
authors.initials: PA
authors.lastname: Testoni
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology; D059248:Chemoradiotherapy / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Anorectal function; Chemoradiotherapy; Faecal incontinence; Manometry; Rectal cancer