Long-term effects of neoadjuvant chemoradiotherapy followed by sphincter-preserving resection on anal sphincter function in relation to quality of life among locally advanced rectal cancer patients: a cross-sectional analysis.

Zerrin Ozgen,Beste M Atasoy,Hazan Ozyurt,Nese Imeryuz,Sevgi Ozden,Rasim Gencosmanoglu

doi:10.1186/s13014-015-0479-4

Abstract

BackgroundThere is growing recognition for the consequences of rectal cancer treatment to maintain an adequate functional sphincter in the long-term rather than preserving the anal sphincter itself. This study aims to evaluate long-term effects of neoadjuvant chemoradiotherapy (nCRT) followed by sphincter-preserving resection on anal sphincter function in relation to quality of life (QoL) among locally advanced rectal cancer patients.MethodsTwenty-nine patients treated with nCRT followed by low anterior resection surgery were included in this study. Data on patient demographics, tumor location and symptoms of urgency and fecal soiling were recorded and evaluated with respect to Wexner Fecal Incontinence Scoring Scale, European Organization for Research and Cancer (EORTC) cancer-specific (EORTC QLQ-C30) and colorectal cancer-specific (EORTC QLQ-CR38) questionnaires and anorectal manometrical findings. Correlation of manometrical findings with Wexner Scale, EORTC QLQ-CR38 scores and EORTC QLQ-C30 scores was also evaluated.ResultsMedian follow-up was 45.6 months (ranged 7.5–98 months. Higher scores for incontinence for gas (p = 0.001), liquid (p = 0.048) and solid (p = 0.019) stool, need to wear pad (p = 0.001) and alteration in life style (p = 0.004) in Wexner scale, while lower scores for future perspective (p = 0.010) and higher scores for defecation problems (p = 0.001) in EORTC QLQ-CR38 were noted in patients with than without urgency. Manometrical findings of resting pressure (mmHg) was positively correlated with body image (r = 0.435, p = 0.030) and sexual functioning (r = 0.479, p = 0.011) items of functional scale, while rectal sensory threshold (RST) volume (mL) was positively correlated with defecation problems (r = 0.424, p = 0.031) items of symptom scale in EORTC QLQ-CR38 and negatively correlated with social function domain (r = −0.479, p = 0.024) in EORTC QLQ-C30. RST volume was also positively correlated with Wexner scores including incontinence for liquid stool (r = 0.459, p = 0.024), need to wear pad (r = 0.466, p = 0.022) and alteration in lifestyle (r = 0.425, p = 0.038).ConclusionThe high risk of developing functional anal impairment as well as the systematic registration of not only oncological but also functional and QoL related outcomes seem important in rectal cancer patients in the long-term disease follow-up.

Highlights

There is growing recognition for the consequences of rectal cancer treatment to maintain an adequate functional sphincter in the long-term rather than preserving the anal sphincter itself
Improved neoadjuvant chemoradiotherapy scheduling and planning have been associated with welldocumented oncological benefits including down-staging and downsizing of the tumor leading increased tumor resectability and the higher likelihood of sphincterpreserving surgery [1,2,3,4]
This translated to a larger population of rectal cancer ‘survivors’ and increased proportion of number of rectal cancer patients who can maintain the continuity of the intestine due to more frequent use of sphincter-preserving surgery by means of increased usage of neoadjuvant chemoradiotherapy (nCRT), improved surgical technique and stapling devices [3, 5, 6]

Summary

Introduction

There is growing recognition for the consequences of rectal cancer treatment to maintain an adequate functional sphincter in the long-term rather than preserving the anal sphincter itself. This study aims to evaluate long-term effects of neoadjuvant chemoradiotherapy (nCRT) followed by sphincter-preserving resection on anal sphincter function in relation to quality of life (QoL) among locally advanced rectal cancer patients. Combined with advancement of surgical techniques, substantial improvement occurred in survival from rectal cancer over the past two decades [5,6,7,8] This translated to a larger population of rectal cancer ‘survivors’ and increased proportion of number of rectal cancer patients who can maintain the continuity of the intestine due to more frequent use of sphincter-preserving surgery by means of increased usage of nCRT, improved surgical technique and stapling devices [3, 5, 6]. A growing body of evidence indicate that both preoperative radiotherapy and sphincter-preserving resection are likely to impair anorectal and sexual functions leading persistent dysfunctional symptoms which may have the potential to significantly impact on quality of life (QoL) [9,10,11,12], even more than a permanent stoma after abdominoperineal excision (APE) [13, 14].

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