Paola De Nardi1, Sabrina Gloria Giulia Testoni2, Maura Corsetti3, Hulda Andreoletti4, Patrizia Giollo2, Sandro Passaretti2, Pier Alberto Testoni2. 1. Gastrointestinal Surgery, San Raffaele Scientific Institute, Milan, Italy. Electronic address: denardi.paola@hsr.it. 2. Gastroenterology Division, San Raffaele Scientific Institute, Milan, Italy. 3. National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK. 4. Service de Anesthésiologie,Etablissements Hospitaliers du Nord Vaudois, Yverdon-les-Bain, Switzerland.
Abstract
BACKGROUND: An altered anorectal function is reported after chemoradiotherapy (CRT) and surgery for rectal cancer. AIM: 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.
BACKGROUND: An altered anorectal function is reported after chemoradiotherapy (CRT) and surgery for rectal cancer. AIM: 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: Jonathan B Yuval; Hannah M Thompson; Canan Firat; Floris S Verheij; Maria Widmar; Iris H Wei; Emmanouil Pappou; J Joshua Smith; Martin R Weiser; Philip B Paty; Garrett M Nash; Jinru Shia; Marc J Gollub; Julio Garcia-Aguilar Journal: Dis Colon Rectum Date: 2022-04-01 Impact factor: 4.585
Authors: Jin Sook Song; In Ja Park; Jeong Hye Kim; Hyang Ran Lee; Jeong Rang Kim; Jong Lyul Lee; Yong Sik Yoon; Chan Wook Kim; Seok Byung Lim; Chang Sik Yu; Jin Cheon Kim Journal: Oncotarget Date: 2017-08-27