Abstract
BackgroundNeoadjuvant chemoradiation therapy followed by curative surgery has gained acceptance as the therapy of choice in locally advanced rectal cancer. However, deterioration of anorectal function after long-course neoadjuvant chemoradiation therapy combined with surgery for rectal cancer is poorly defined. The aim of this study was to evaluate the physiological and clinical change of anorectal function after neoadjuvant chemoradiation therapy for rectal cancer.MethodsWe analyzed 30 patients on whom preoperative anorectal manometry data were available both before and after chemoradiation from October 2010 to September 2011. All patients underwent long-course neoadjuvant chemoradiation therapy. We compared manometric parameters between before and after neoadjuvant chemoradiation therapy.ResultsOf 30 patients, 20 were males and 10 females. The mean age was 64.9 ± 9.9 years (range, 48-82). Before nCRT, the rectal compliance was higher in patients with ulceroinfiltrative type (P = 0.035) and greater involvement of luminal circumference (P = 0.017). However, there was the tendency of increased rectal sensory threshold for desire to defecate when the patient had decreased circumferential ratio of the tumor (P = 0.099), down-graded T stage (P = 0.016), or reduced tumor volume (P = 0.063) after neoadjuvant chemoradiation.ConclusionsNeoadjuvant chemoradiation therapy did not significantly impair overall sphincter function before radical operation. The relationship between tumor response of chemoradiation and sensory threshold for desire to defecate may suggest that neoadjuvant chemoradiation may be helpful for defecatory function as well as local disease control, at least in the short-term period after the radiation in locally advanced rectal cancer patients.
Highlights
Neoadjuvant chemoradiation therapy followed by curative surgery has gained acceptance as the therapy of choice in locally advanced rectal cancer
There was a marginal difference in the maximal rectal sensory threshold between before and after Neoadjuvant chemoradiation therapy (nCRT) (179.3 ± 63.7 ml vs 151.7 ± 53.4 ml, P = 0.073) without a difference in rectal compliance (P = 0.638) (Table 1)
When we considered the effect of nCRT on tumor, there were twenty two patients who underwent the change of tumor gross morphology after nCRT, ten patients with reduced circumferential ratio (CIR) after nCRT, eight patients with down-staging in T-stage, and four patients with more than 70% of volume reduction of tumor after nCRT
Summary
Neoadjuvant chemoradiation therapy followed by curative surgery has gained acceptance as the therapy of choice in locally advanced rectal cancer. Deterioration of anorectal function after long-course neoadjuvant chemoradiation therapy combined with surgery for rectal cancer is poorly defined. The aim of this study was to evaluate the physiological and clinical change of anorectal function after neoadjuvant chemoradiation therapy for rectal cancer. Neoadjuvant chemoradiation therapy (nCRT) followed by curative surgery has become the therapy of choice in locally advanced rectal cancer. Low anterior resection (LAR) with total mesorectal excision (TME) is the standard surgical procedure in sphincter-preserving. Deterioration of anorectal function after nCRT combined with sphincter-preserving surgery (SPS) for rectal cancer may happen. Worsening of anorectal function after nCRT for locally advanced rectal cancer is often referred as radiation damage of the anorectum and pelvic floor [8,9]
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