Susanne Haas1,2, Pia Faaborg2,3, Donghua Liao4, Søren Laurberg1,2, Hans Gregersen5, Lilly Lundby1,2, Peter Christensen1,2, Klaus Krogh2,6. 1. a Department of Surgery , Aarhus University Hospital , Aarhus N , Denmark. 2. b Danish Cancer Society Centre for Research and Late Adverse Effects After Cancer in the Pelvic Organs , Aarhus University Hospital , Aarhus N , Denmark. 3. c Department of Surgery , Vejle Hospital , Vejle , Denmark. 4. d GIOME Academia, Department of Clinical Medicine , Aarhus University , Aarhus N , Denmark. 5. e GIOME, Department of Surgery , Prince of Wales Hospital and Chinese University of Hong Kong , Hong Kong , Hong Kong SAR. 6. f Neurogastroenterology Unit, Department of Hepatology and Gastroenterology , Aarhus University Hospital , Århus C , Denmark.
Abstract
BACKGROUND: Sphincter-sparing radiotherapy or chemoradiation are standard treatments for patients with anal cancer. The ultimate treatment goal is full recovery from anal cancer with preserved anorectal function. Unfortunately, long-term survivors often suffer from severe anorectal symptoms. The aim of the present study was to characterize changes in anorectal physiology after radiotherapy for anal cancer. METHOD: We included 13 patients (10 women, age 63.4 ± 1.9) treated with radiotherapy or chemoradiation for anal cancer and 14 healthy volunteers (9 women, age 61.4 ± 1.5). Symptoms were assessed with scores for fecal incontinence and low anterior resection syndrome. Anorectal physiology was examined with anorectal manometry and the Functional Lumen Imaging Probe. RESULTS: Patients had a median Wexner fecal incontinence score of 5 (0-13) and a median LARS score of 29 (0-39). Compared to healthy volunteers, patients had lower mean (±SE) anal -resting (38 ± 5 vs. 71 ± 6, p < .001) and -squeeze pressures (76 ± 11 vs. 165 ± 15, p < .001). Patients also had lower anal yield pressure (15.5 ± 1.3 mmHg vs. 28.0 ± 2.0 mmHg, p < .001), higher distensibility, and lower resistance to flow (reduced resistance ratio of the anal canal during distension, q = 5.09, p < .001). No differences were found in median (range) rectal volumes at first sensation (70.5 (15-131) vs. 57 (18-132) ml, p > .4), urge (103 (54-176) vs. 90 (32-212), p > .6) or maximum tolerable volume (173 (86-413) vs. 119.5 (54-269) ml, p > .10). CONCLUSION: Patients treated with radiotherapy or chemoradiation for anal cancer have low anal resting and squeeze pressures as well as reduced resistance to distension and flow.
BACKGROUND: Sphincter-sparing radiotherapy or chemoradiation are standard treatments for patients with anal cancer. The ultimate treatment goal is full recovery from anal cancer with preserved anorectal function. Unfortunately, long-term survivors often suffer from severe anorectal symptoms. The aim of the present study was to characterize changes in anorectal physiology after radiotherapy for anal cancer. METHOD: We included 13 patients (10 women, age 63.4 ± 1.9) treated with radiotherapy or chemoradiation for anal cancer and 14 healthy volunteers (9 women, age 61.4 ± 1.5). Symptoms were assessed with scores for fecal incontinence and low anterior resection syndrome. Anorectal physiology was examined with anorectal manometry and the Functional Lumen Imaging Probe. RESULTS:Patients had a median Wexner fecal incontinence score of 5 (0-13) and a median LARS score of 29 (0-39). Compared to healthy volunteers, patients had lower mean (±SE) anal -resting (38 ± 5 vs. 71 ± 6, p < .001) and -squeeze pressures (76 ± 11 vs. 165 ± 15, p < .001). Patients also had lower anal yield pressure (15.5 ± 1.3 mmHg vs. 28.0 ± 2.0 mmHg, p < .001), higher distensibility, and lower resistance to flow (reduced resistance ratio of the anal canal during distension, q = 5.09, p < .001). No differences were found in median (range) rectal volumes at first sensation (70.5 (15-131) vs. 57 (18-132) ml, p > .4), urge (103 (54-176) vs. 90 (32-212), p > .6) or maximum tolerable volume (173 (86-413) vs. 119.5 (54-269) ml, p > .10). CONCLUSION:Patients treated with radiotherapy or chemoradiation for anal cancer have low anal resting and squeeze pressures as well as reduced resistance to distension and flow.
Authors: Pavel Vítek; Jiří Kubeš; Vladimír Vondráček; Michal Andrlik; Matěj Navrátíl; Radek Zapletal; Alexandra Haas; Kateřina Dědečková; Barbora Ondrová; Alexander Grebenyuk; Jozef Rosina Journal: Cancers (Basel) Date: 2021-12-31 Impact factor: 6.639
Authors: Michał M Nowakowski; Mateusz Rubinkiewicz; Natalia Gajewska; Grzegorz Torbicz; Michał Wysocki; Piotr Małczak; Piotr Major; Mateusz Wierdak; Andrzej Budzyński; Michał Pędziwiatr Journal: Wideochir Inne Tech Maloinwazyjne Date: 2018-07-03 Impact factor: 1.195