title: Anal function after endoluminal locoregional resection by transanal endoscopic microsurgery and radiotherapy for rectal cancer.
abstract: OBJECTIVE
  In patients with rectal cancer, surgery and chemoradiotherapy may affect anal sphincter function. Few studies have evaluated anorectal function after neoadjuvant chemoradiotherapy (n-CRT) and/or transanal endoscopic microsurgery (TEM). The aim of this study was to evaluate the effects of n-CRT and TEM on anorectal function.
  
  
  METHODS
  Thirty-seven patients with rectal cancer underwent anorectal manometry and Wexner scoring for faecal incontinence at baseline, after n-CRT (cT2-T3N0 cancer) and at 4 and 12 months after surgery. Water-perfused manometry measured anal tone at rest and during squeezing, rectal sensitivity and compliance. Twenty-seven and 10 patients, respectively, underwent TEM without (Group A) or with n-CRT (Group B).
  
  
  RESULTS
  In Group A, anal resting pressure decreased from 68 ± 23 to 54 ± 26 mmHg at 4 months (P = 0.04) and improved 12 months after surgery (60 ± 30 mmHg). The Wexner score showed a significant increase in gas incontinence (59%), soiling (44%) and urgency (37%) rates at 4 months, followed by clinical improvement at 1 year (41%, 26% and 18%, respectively). In group B, anal resting pressure decreased from 65 ± 23 to 50 ± 18 mmHg at 4 months but remained stable at 12 months (44 ± 11 mmHg, P = 0.02 vs preoperative values - no significant difference compared with evaluation at 4 months). Gas incontinence, soiling and urgency were observed in 50%, 50%, 25% and in 38%, 12% and 12% of cases, respectively, 4 and 12 months after treatment.
  
  
  CONCLUSIONS
  TEM does not significantly affect anal function. Instead, n-CRT does affect anal function but without causing major anal incontinence.
authors.affiliation: Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Biviano
authors.affiliation: Department of General Surgery and Surgical Specialties 'Paride Stefanini', Sapienza University of Rome, Rome, Italy.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-0182-8761
authors.initials: A
authors.lastname: Balla
authors.affiliation: Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Badiali
authors.affiliation: Department of General Surgery and Surgical Specialties 'Paride Stefanini', Sapienza University of Rome, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Quaresima
authors.affiliation: Department of General Surgery and Surgical Specialties 'Paride Stefanini', Sapienza University of Rome, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: D'Ambrosio
authors.affiliation: Department of General Surgery and Surgical Specialties 'Paride Stefanini', Sapienza University of Rome, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Lezoche
authors.affiliation: Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Corazziari
authors.affiliation: Department of General Surgery and Surgical Specialties 'Paride Stefanini', Sapienza University of Rome, Rome, Italy.
authors.forename: A M
authors.initials: AM
authors.lastname: Paganini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology* / Q000601:surgery; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011184:Postoperative Period; D011312:Pressure; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D012146:Rest / Q000502:physiology; D012189:Retrospective Studies; D000067369:Transanal Endoscopic Microsurgery / Q000009:adverse effects* / Q000379:methods
keywords: Rectal cancer; endoluminal loco-regional resection; manometric evaluation; neoadjuvant chemo-radiotherapy; transanal endoscopic microsurgery