Manometric evaluation of anorectal function in patients treated with neoadjuvant chemoradiotherapy and total mesorectal excision for rectal cancer. Issue 1 (January 2017)

• Record Type: Journal Article
• Authors: De Nardi, Paola; Testoni, Sabrina Gloria Giulia; Corsetti, Maura; Andreoletti, Hulda; Giollo, Patrizia; Passaretti, Sandro; Testoni, Pier Alberto
• Is Part Of: Digestive and liver disease. Volume 49:Issue 1(2017)
• Page Start: 91
• Page End: 97
• Publication Date: 2017-01
• Subjects: Anorectal function -- Chemoradiotherapy -- Faecal incontinence -- Manometry -- Rectal cancer; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2016.09.005
• Languages: English
• ISSNs: 1590-8658

Abstract

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.