Abstract
Preoperative chemoradiotherapy (PCRT) is a standard treatment for locally advanced rectal cancer. The influence of PCRT on anorectal function has not been objectively assessed. We evaluated the short-term influence of PCRT on anorectal function in patients with locally advanced rectal cancer using anorectal manometry. We included 310 patients with locally advanced mid and lower rectal cancer who underwent PCRT from 2012 to 2015. We compared anorectal function based on anorectal manometry between before and after PCRT according to tumor location, clinical T (cT) stage, and tumor response after PCRT. Lower rectal cancer was common in the cohort of 310 patients (n = 228, 73.5%). Sphincter length (p = 0.003) and maximal resting pressure (p < 0.001) increased and maximal tolerated volume (p = 0.036) decreased after PCRT regardless of tumor location. Maximal squeezing pressure and rectal compliance slightly decreased, without statistical significance. Changes in manometric parameters after PCRT were not associated with changes of cT stage after PCRT. However, minimal sensory volume (p = 0.042) and maximal tolerated volume (p = 0.025) increased significantly in 143 patients (46.1%) with changes in the distance of the cancer from the anal verge after PCRT. PCRT did not impair the overall short-term anorectal manometric parameters in patients with locally advanced rectal cancer. Further study is required to investigate postoperative anorectal function after sphincter-preserving surgery to evaluate the long-term effects of PCRT on anorectal function.
Highlights
Preoperative chemoradiotherapy (PCRT) is currently recommended as the standard treatment for locally advanced rectal cancer [1,2,3]
The mean distance of the tumor from the anal verge (AV) was 4.48 ± 1.36 cm, and lower rectal cancer patients were predominant in the cohort
The present study compared the results from before and after PCRT with the objective of assessing the direct influence of PCRT on anorectal function, for which changes in manometric parameters were observed as comparisons of objective indices
Summary
Preoperative chemoradiotherapy (PCRT) is currently recommended as the standard treatment for locally advanced rectal cancer [1,2,3]. Many patients with rectal cancer wish to undergo sphincter-preserving surgery (SPS) to preserve quality of life. Anorectal function is compromised and quality of life is affected [8,9,10,11] It is www.impactjournals.com/oncotarget known that the possibility of SPS increases after PCRT, but there are conflicting opinions over whether SPS after PCRT causes more severe anorectal dysfunction than SPS. Previous studies have reported that patients with SPS after PCRT can develop fecal incontinence [3] due to anorectal functional deterioration [1, 3, 12,13,14] more frequently than patients who underwent surgery alone, and that PCRT causes damage to the anal sphincter and pudendal nerve [15]
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