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Research ArticleClinical Studies

The Influence of Neoadjuvant Chemoradiation for Middle and Lower Rectal Cancer on Anorectal Function

YUGO HIRATA, HIROAKI NOZAWA, KAZUSHIGE KAWAI, KEISUKE HATA, TOSHIAKI TANAKA, TAKESHI NISHIKAWA, KAZUHITO SASAKI, MANABU KANEKO, SHIGENOBU EMOTO, KOJI MURONO, HIROFUMI SONODA and SOICHIRO ISHIHARA
Anticancer Research April 2020, 40 (4) 2199-2208; DOI: https://doi.org/10.21873/anticanres.14181
YUGO HIRATA
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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  • For correspondence: yuhirata-tuk@umin.ac.jp
HIROAKI NOZAWA
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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KAZUSHIGE KAWAI
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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KEISUKE HATA
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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TOSHIAKI TANAKA
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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TAKESHI NISHIKAWA
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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KAZUHITO SASAKI
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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MANABU KANEKO
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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SHIGENOBU EMOTO
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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KOJI MURONO
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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HIROFUMI SONODA
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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SOICHIRO ISHIHARA
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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Abstract

Background/Aim: To date, there is no clear understanding whether preoperative long-course chemoradiotherapy combined with surgery for rectal cancer is detrimental to anorectal function. The purpose of this study was to clarify the influence of preoperative chemoradiotherapy and surgery for middle and lower rectal cancer on postoperative anorectal function. Patients and Methods: Data of 113 patients with middle or lower rectal cancer treated with preoperative chemoradiotherapy plus surgery or surgery alone between January 2013 and December 2016 were analyzed. A total of 84 and 29 patients underwent low anterior resection and intersphincteric resection, respectively. In patients with T3 or deeper and with any N stage cancer below peritoneal reflection, surgery plus lateral lymph node dissection or preoperative radiation (total: 50.4 Gy/28 fractions) to the pelvis with chemoradiotherapy plus surgery was treated. Anorectal function was assessed prior to treatment and 6 and 12 months postoperatively. Specifically, maximum resting pressure and maximum squeezing pressures were measured. The Wexner score was recorded prior to treatment and 12 months postoperatively. Results: maximum resting pressure and maximum squeezing pressure decreased post-surgery in both groups. Maximum resting pressure and maximum squeezing pressure at 12 months and the Wexner score at 12 months post-surgery were comparable among patients treated with chemoradiotherapy plus surgery and those treated with surgery alone. Conclusion: Preoperative chemoradiotherapy did not clearly impair postoperative anorectal function in patients who underwent low anterior resection and intersphincteric resection.

  • Rectal cancer
  • anorectal function
  • chemoradiotherapy
  • neoadjuvant
  • manometry

Anorectal function following pelvic surgery is relatively preserved following the introduction of total mesorectal excision (TME). However, several reports have shown an impaired postoperative anorectal function in 30% to 76% of patients following TME, with or without preoperative chemoradiotherapy (CRT) (1-4).

Currently, preoperative CRT is considered the gold standard treatment for reducing local recurrence of advanced middle and low rectal cancer (5-7). Several studies reported an increased risk of postoperative anorectal dysfunction following preoperative CRT (8-12). Numerous past studies utilized questionnaires to evaluate anorectal functions such as Wexner continence score (13), St. Mark's score (14), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (15). However, to date, there is still a limited number of reports on anorectal function assessment via manometric approach in such patients (16-18). Moreover, small number of patients, single arm, or measurements at only 1-2 timepoints represent limitations in these studies (16-18).

The purpose of this study was to clarify the influence of preoperative CRT and surgery for middle and lower rectal cancer on postoperative anorectal function via manometric and questionnaire approaches.

Patients and Methods

Patients. We examined consecutive patients who underwent curative surgery for middle or low rectal cancer at the University of Tokyo Hospital between January 2013 and December 2016. The patients were followed-up for at least 1 year postoperatively. Tumor location was determined with the following approaches: Digital rectal examination, endoscopy, barium enema, with/without pelvic magnetic resonance imaging. All patients were treated by low anterior resection (LAR) or intersphincteric resection (ISR) following TME surgery principles as mentioned below (19). We excluded tumors that involved the anal canal from the analysis. For each patient, we collected data associated with their demographics, preoperative assessment and therapies, postoperative follow-up, and histological outcomes.

The study obtained approval from the Ethics Committee of the University of Tokyo (reference no. 10046). The study was conducted in accordance to Declaration of Helsinki for human research.

Neoadjuvant treatment. Patients were staged according to the eighth edition of the American Joint Committee on Cancer Staging Manual (20). Patients with stage T3 or deeper and with N0 or deeper cancer below the peritoneal reflection were treated with surgery plus lateral lymph node dissection (LLND) or preoperative CRT plus surgery. Specifically, preoperative CRT was administered with the following regimen: 50.4 Gy (1.8 Gy × 28 fractions) to the pelvis concomitant with oral tegafur-uracil (300 mg/m2) and leucovorin (75 mg/m2) for 28 days as previously described (21). Regarding the radiation method, planning computed tomographic images were acquired with 2-mm slice thickness. A three-dimensional conformal technique was used with planning computed tomography. The entire pelvis was treated with the four-field technique and uniform planning target volume margins of 5 mm in the lateral, anteroposterior, and cranio-caudal directions were applied. The TME surgical operation was performed 6-10 weeks following CRT completion.

Surgical procedures. Surgical procedures included LAR and ISR. These were completed via conventional open approach, laparoscopic surgery, or robotic surgery. The selection of LAR or ISR procedure was based on whether the tumor was located within 2 cm of the upper border of the anal canal. The anastomotic technique was performed employing the double-stapling technique or the handsewn technique in LAR cases. In contrast, anastomoses were made using the handsewn technique in all ISR cases. We performed bilateral pelvic wall lymph node dissection in patients with T3 or deeper low rectal cancer below the peritoneal reflection unless they did not undergo CRT. On the contrary, in patients receiving CRT, we performed LLND selectively when lateral lymph nodes were suspected of metastasizing prior to CRT (22). In LAR cases, a diverting stoma was constructed at the discretion of the operating surgeons. On the other hand, a diverting stoma was constructed in all ISR cases.

Assessment of anal function. In the manometric approach for anal function, a one-channel catheter (GMMS-100R-SI instrument; Star Medical, Tokyo, Japan) was inserted into the rectum in the left decubitus position. We measured the maximum resting pressure (MRP) and maximum squeezing pressure (MSP) using the rapid pull-through technique. MSP was measured in increments above the resting pressure. We excluded patients with outlying manometric data, such as preoperative MSP less than 70 mmHg, and postoperative MRP or MSP more than twice as high as preoperatively. Measurements were carried out at the following timepoints: Before treatment (baseline), and at 6 and 12 months postoperatively. Manometric data at each timepoint are presented as ratios of the baseline values.

The score of Jorge and Wexner (Wexner score) was used to evaluate anal incontinence (13). The higher the score, the more severe the anal incontinence, ranging from 0 to 20. Wexner score was evaluated before treatment (baseline) and 12 months postoperatively, and their difference was analyzed. We excluded patients who did not undergo stomal closure at 12 months post-surgery. The frequency of daily bowel movement was queried at 12 months postoperatively.

Statistical analyses. Date have been provided as the mean±standard error. Patient demographics and tumor characteristics were compared using chi-square test for categorical variables or Mann–Whitney U-test for continuous variables. The MRP, MSP, Wexner score, and frequency of daily bowel movement were compared between the two groups using Mann–Whitney U-test. All statistical analyses were performed by the use of JMP software version 14 (SAS Institute Inc., Cary, NC, USA). Values of p<0.05 were considered statistically significant.

Results

We selected 168 patients with middle or lower rectal cancer. They were treated with preoperative chemoradiotherapy plus surgery or surgery alone. A total of 123 and 45 patients underwent LAR and ISR, respectively.

Effects of preoperative CRT in LAR cases. A total of 83 patients underwent LAR without neoadjuvant CRT, whereas 40 patients underwent LAR after neoadjuvant CRT. Of the 123 LAR cases, 39 patients were excluded. Exclusion criteria were as follows: Refusal in 19 (15%), lost to follow-up in 16 (13%), and outlying manometric data in four (3%). Thus, finally 58 patients in the group treated with surgery alone and 26 patients in the CRT plus surgery group were analyzed (Figure 1).

Table I outlines the patient demographics, tumor characteristics, and treatment data. The distance between the lower edge of tumor and the anal verge in the CRT plus surgery group was shorter than that in the surgery alone group by 2.2 cm (p<0.0001). More advanced clinical and pathological T-stages were observed in the CRT plus surgery group. A diverting stoma was more frequently created in the CRT plus surgery group (73% vs. 43%, respectively; p=0.011). No significant difference was observed between the two groups in other parameters (i.e. age, gender, body mass index, clinical and pathological N-stage, adjuvant chemotherapy, LLND, surgical approaches, and anastomotic technique).

MRP and MSP values before treatment were similar in the group treated with surgery alone group and the CRT plus surgery group (MRP: 58.3±2.8 vs. 50.1±4.2, p=0.11; MSP: 218.0±13.1 vs. 203.9±19.6 p=0.55). Figure 2 shows the changes from baseline in MRP and MSP at 6 and 12 months post-surgery in both groups. Between baseline and 6 months, MRP decreased by 21% in that treated with surgery alone (p<0.0001) and by 22% in the CRT plus surgery group (p<0.0001). No difference was observed in MRP at 6 and 12 months between the two groups (p=0.97 and p=0.24, Figure 2A). Between baseline and 6 months, MSP decreased by 12% in the group treated with surgery alone (p=0.003) and by 21% in that treated with CRT plus surgery (p<0.0001). Additionally, MSP did not differ at 6 and 12 months between the two groups (p=0.19 and p=0.062, respectively, Figure 2B). We did not observe the recovery of MRP and MSP from 6 to 12 months post-surgery in the two groups.

Figure 1.
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Figure 1.

Flow diagram of the prospective study in low anterior resection cases.

When analyzing the Wexner score, two patients in each group were further excluded from the analysis due to the presence of a protective stoma 1 year after LAR. Thus, finally we analyzed 56 patients in the group treated with surgery alone and 24 in that treated with CRT plus surgery. The baseline Wexner score was similar in the groups (1.8±0.4 vs. 2.8±0.6, respectively; p=0.17). Figure 3 shows the comparison of the change in the Wexner score between baseline and 12 months. The Wexner score increased postoperatively in both groups. We did not observe a significant intergroup difference (p=0.54). The frequency of daily bowel movement at 12 months postoperatively in the CRT plus surgery group was higher than that in the group treated with surgery alone (4.3±0.7 vs. 7.3±1.1, respectively; p=0.019).

Effects of preoperative CRT in ISR cases. A total of 24 patients underwent ISR without preoperative CRT and 21 patients underwent ISR after preoperative CRT. Of the 45 ISR cases, 16 patients were excluded. Exclusion criteria were as follows: refusal in seven (16%), lost to follow-up in seven (16%) and outlying manometrics in two (4%). Finally, we analyzed 14 patients in the group treated with surgery alone and 15 in the group treated with CRT and surgery (Figure 4).

Table II describes patient demographics, tumor characteristics, and treatment data. We noted older age in the CRT plus surgery group. The clinical T-stage in the CRT plus surgery group was more advanced than that in the group treated with surgery alone (p=0.0008). The pathological N-stage was more advanced in the group treated with surgery alone (p=0.030). Of note, no significant difference in other parameters between the two groups was observed (i.e. gender, body mass index, tumor location from the anal verge, clinical N-stage, pathological T-stage, adjuvant chemotherapy, LLND, surgical approaches, anastomotic technique, and diverting stoma rate).

MRP and MSP values before treatment were similar in the two groups. Figure 5 shows MRP and MSP changes at 6 and 12 months post-surgery from the baseline in the two groups. We found that MRP decreased between baseline and 6 months by 22% in the group treated with surgery alone (p<0.0001) and by 43% in the CRT plus surgery group (p<0.0001). Of note, MRP did not differ at 6 and 12 months between the two groups (p=0.055 and p=0.78, Figure 5A). We observed that MSP decreased between baseline and 6 months by 11% in that treated with surgery alone (p=0.006) and by 33% in the CRT plus surgery group (p<0.0001). Additionally, MSP in the CRT plus surgery group was lower than that in the surgery alone group at 6 months post-surgery (p=0.027, Figure 5B), but no significant difference was observed between the two groups at 12 months post-surgery (p=0.33, Figure 5B). MRP and MSP recovery from 6 to 12 months post-surgery was not observed in the two groups.

Three patients in the group treated with surgery alone and four in the CRT plus surgery group were further excluded from the analysis of the Wexner score due to the presence of stoma 1 year after ISR. Thus, we finally analyzed 11 patients in the group treated with surgery alone group and 11 patients in the CRT plus surgery group. The baseline Wexner score was similar in the two groups (1.0±1.0 vs. 3.1±1.0, respectively; p=0.14). The Wexner score increased postoperatively in both groups (6.1±1.6 vs. 8.4±1.6, respectively; p=0.33). No significant intergroup difference was observed in the change in Wexner score between baseline and 12 months (p=0.93, Figure 6). The frequency of daily bowel movement did not differ in the two groups (5.3±1.2 vs. 5.1±1.1, respectively; p=0.91).

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Table I.

Demographics, tumor characteristics, and treatment in patients who underwent low anterior resection (n=84).

Discussion

In this prospective observational study, we evaluated the influence of long-course preoperative CRT in patients with middle and lower rectal cancer on anorectal function. To this end, we compared the group treated with surgery alone and that treated with CRT plus surgery. It has been shown by numerous studies on anorectal function that preoperative CRT can impair postoperative anorectal function (2, 10, 11, 23-25). However, in several of these reports, enrolled patients had upper rectal cancer. Moreover, postoperative anorectal function was evaluated exclusively with a questionnaire. In contrast, we compared postoperative anorectal function between patients with and without preoperative CRT who underwent LAR or ISR. Furthermore, in the present study, both manometric data and the Wexner score were measured at multiple timepoints.

Table III summarizes both previous and our results as to anorectal function evaluated by manometry in patients treated with perioperative radiotherapy. Depending on the study, there are differences in terms of timing, anorectal function evaluation methods, and treatment. About a half of the studies concluded that preoperative CRT did not impair postoperative anorectal function. The remaining reported that radiotherapy or CRT increased the risk of postoperative incontinence. However, such findings have limitations. Specifically, Nardi et al. evaluated anorectal function only in patients treated by preoperative CRT (24). Inhat et al. evaluated anorectal function at only one postoperative timepoint (18). Gervaz et al. reported that postoperative MRP in the CRT plus surgery group decreased more compared with the group treated with surgery alone, whereas they did not find a difference in MSP between the two groups (25). However, tumor location and anastomosis level in the CRT plus surgery group were lower than in that which underwent surgery alone. Of note, Ammann et al. (17) and Canda et al. (26) used a CRT regimen and evaluation methods for anorectal function which resembled those in our study. Additionally, Ammann et al. reported that postoperative MRP in the CRT plus surgery group decreased more than in the group treated with surgery alone (17). However, the authors did not determine the timing of postoperative analysis, with an interquartile range of 149-405 days. Of note, Canda et al. reported similar results. However, in their study cohort, tumor location in the CRT plus surgery group was significantly lower than that in the group treated with surgery alone (26).

Figure 2.
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Figure 2.

Changes in maximum resting pressure (MRP; A) and incremental maximum squeezing pressure (iMSP; B) at 6 and 12 months after low anterior resection from baseline in the group treated with surgery alone and that treated with chemoradiotherapy (CRT) plus surgery. MRP did not differ significantly between the two groups at 6 months (p=0.97) and 12 months (p=0.24). iMSP did not differ significantly between the two groups at 6 months (p=0.19) and 12 months (p=0.62). Significantly different from baseline at ***p<0.0001 and *p<0.04 for surgery alone, and ###p<0.0001 for CRT plus surgery.

We noted the anorectal function for LAR and ISR to mitigate the influence of the level of anastomosis. We found that the anorectal function was impaired after LAR and ISR regardless of preoperative CRT. Notably, postoperative anorectal function in the CRT plus surgery group, with the tumor location being lower, did not differ from that in the group treated with surgery alone in LAR cases. In a study performed by Kushwaha et al., the authors reported that radiotherapy did not affect MRP and MSP at 6 weeks and 6 months post-treatment completion in patients with prostate or bladder cancer (27). Similarly, Jang et al. concluded that anorectal function at 4-7 weeks post-CRT completion was unchanged from pretreatment in patients with middle and lower rectal cancer (28). However, several studies have reported that rectal surgery itself impairs anal manometric data. Specifically, Kitaguchi et al. reported that regardless of preoperative CRT, a significant decrease of MRP and MSP was observed after ISR (by 35% and 10%, respectively) (29). Our findings are in line with such results. It has been suggested that physical deformity and denervation-induced pressure disproportion of the anal canal may reduce anorectal function analyzed by three-dimensional manometry even in LAR (30). Current progress in radiation technology is prominent. At our Institute, a three-dimensional conformal technique with planning by thin-slice images was applied in order to avoid unnecessary irradiation. Intensity-modulated radiation therapy has gradually replaced four-field box radiotherapy for rectal cancer in western countries (31). In the future, a more improved radiation technique will ensure sparing the anal canal.

Figure 3.
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Figure 3.

Difference between preoperative and postoperative Wexner scores in the low anterior resection group treated with surgery alone and that treated with chemoradiotherapy (CRT) plus surgery. Bars are the range of scores. Boxes are the range from 1st quartile to 3rd quartile. Lines are median.

Figure 4.
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Figure 4.

Flow diagram of the prospective study in intersphincteric resection cases.

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Table II.

Demographics, tumor characteristics, and treatment in patients who underwent intersphincteric resection (n=29).

Figure 5.
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Figure 5.

Changes in maximum resting pressure (MRP; A) and incremental maximum squeezing pressure (MSP; B) at 6 and 12 months after intersphincteric resection from baseline in the group treated with surgery alone and that treated with chemoradiotherapy (CRT) plus surgery. MRP did not differ significantly between the two groups at 6 months (p=0.055) and 12 months (p=0.78). iMSP was significantly lower in the CRT plus surgery group at 6 months (p=0.027) but was not different at 12 months (p=0.33). Significantly different from baseline at ***p<0.0001 and **p<0.006 for surgery alone, and ###p<0.0001 for CRT plus surgery.

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Table III.

Characteristics of articles on anorectal manometry regarding perioperative radiotherapy.

The anastomosis level in the CRT plus surgery group was expected to be lower than that in the group treated with surgery alone because of the difference in the tumor location in LAR cases. Moreover, a diverting stoma in the CRT plus surgery group was more frequently created than that in the surgery alone group. Consequently, the period of disuse of the bowel distal to the stoma in the was longer in the CRT plus surgery group at 12 months after surgery. We consider that these factors would chiefly result in an increased frequency of daily bowel movement.

Our analysis has several limitations. Firstly, it was a single-center study and had a small sample size. There were biases in age, tumor-related factors, and diverting stoma between the two groups. Manometric data after rectal surgery were evaluated regardless of diverting stoma in both groups. The follow-up period was not sufficiently long to evaluate the long-term effects of surgery and neoadjuvant CRT on anorectal function. Finally, we did not compare anorectal function after CRT (pre-surgery) with the baseline before CRT. This is due to the fact that not all patients of the CRT plus surgery group were evaluated at this timepoint.

Figure 6.
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Figure 6.

Difference between the preoperative and postoperative Wexner scores in the group treated with surgery alone and that treated with chemoradiotherapy (CRT) plus surgery. Boxes are the interquartile range, lines are the median and bars are the range of scores.

In conclusion, neoadjuvant CRT in patients with middle and low rectal cancer did not clearly impair postoperative anorectal function at 12 months post-surgery. A larger number of patients and a longer observation period are required to analyze the late effects on anorectal function.

Acknowledgements

This research is supported by Grants-in-Aid for Scientific Research (C: grant number;16K07143, C: grant number;16K07161, C: grant number; 17K10620, C: grant number;17K10621, C: grant number;17K10623 and C: grant number: 18K07194) from Japan Society for the promotion of Science. This research is supported by the Project for Cancer Research and Therapeutic Evolution (P-CREATE, grant number: 18cm0106502h0003) from the Japan Agency for Medical Research and Development (AMED).

Footnotes

  • Authors' Contributions

    Y.H., H.N., K.K., K.H., T.T., T.N., K.S., M.K., S.E., K.M., H.S., and S.I. contributed to the conception, design, or acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for significant intellectual content; and approved the final version for publication.

  • Conflicts of Interest

    None of the Authors has conflicts of interest that would influence this work.

  • Received February 26, 2020.
  • Revision received March 13, 2020.
  • Accepted March 19, 2020.
  • Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved

References

  1. ↵
    1. Emmertsen KJ,
    2. Laurberg S,
    3. the Rectal Cancer Function Study Group
    : Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg 100: 1377-1387, 2013. PMID: 23939851. DOI: 10.1002/bjs.9223
    OpenUrlCrossRefPubMed
  2. ↵
    1. Pollack J,
    2. Holm T,
    3. Cedermark B,
    4. Altman D,
    5. Holmström B,
    6. Glimelius B,
    7. Mellgren A
    : Late adverse effects of short-course preoperative radiotherapy in rectal cancer. Br J Surg 93: 1519-1525, 2006. PMID: 17054311. DOI: 10.1002/bjs.5525
    OpenUrlCrossRefPubMed
    1. Sakr A,
    2. Yang SY,
    3. Kang JH,
    4. Cho MS,
    5. Han YD,
    6. Min BS,
    7. Thabet W,
    8. Elbanna HG,
    9. Morshed M,
    10. Kim NK
    : Oncologic safety and bowel function after ultralow anterior resection with or without intersphincteric resection for low lying rectal cancer: Comparative cross sectional study. J Surg Oncol, 2019. PMID: 31797383. DOI: 10.1002/jso.25791
  3. ↵
    1. Contin P,
    2. Kulu Y,
    3. Bruckner T,
    4. Sturm M,
    5. Welsch T,
    6. Müller-Stich BP,
    7. Huber J,
    8. Büchler MW,
    9. Ulrich A
    : Comparative analysis of late functional outcome following preoperative radiation therapy or chemoradiotherapy and surgery or surgery alone in rectal cancer. Int J Colorectal Dis 29: 165-175, 2014. PMID: 24136155. DOI: 10.1007/s00384-013-1780-z
    OpenUrlCrossRefPubMed
  4. ↵
    1. Bosset JF,
    2. Collette L,
    3. Calais G,
    4. Mineur L,
    5. Maingon P,
    6. Radosevic-Jelic L,
    7. Daban A,
    8. Bardet E,
    9. Beny A,
    10. Ollier JC
    : Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355: 1114-1123, 2006. PMID: 16971718. DOI: 10.1056/NEJMoa060829
    OpenUrlCrossRefPubMed
    1. Folkesson J,
    2. Birgisson H,
    3. Pahlman L,
    4. Cedermark B,
    5. Glimelius B,
    6. Gunnarsson U
    : Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23: 5644-5650, 2005. PMID: 16110023. DOI: 10.1200/JCO.2005.08.144
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Guillem JG,
    2. Chessin DB,
    3. Cohen AM,
    4. Shia J,
    5. Mazumdar M,
    6. Enker W,
    7. Paty PB,
    8. Weiser MR,
    9. Klimstra D,
    10. Saltz L,
    11. Minsky BD,
    12. Wong WD
    : Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg 241: 829-836, 2005. PMID: 15849519. DOI: 10.1097/01.sla.0000161980.46459.96
    OpenUrlCrossRefPubMed
  6. ↵
    1. Lim JF,
    2. Tjandra JJ,
    3. Hiscock R,
    4. Chao MW,
    5. Gibbs P
    : Preoperative chemoradiation for rectal cancer causes prolonged pudendal nerve terminal motor latency. Dis Colon Rectum 49: 12-19, 2006. PMID: 16292664. DOI: 10.1007/s10350-005-0221-7
    OpenUrlPubMed
    1. Bruheim K,
    2. Guren MG,
    3. Skovlund E,
    4. Hjermstad MJ,
    5. Dahl O,
    6. Frykholm G,
    7. Carlsen E,
    8. Tveit KM
    : Late side effects and quality of life after radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys 76: 1005-1011, 2010. PMID: 19540058. DOI: 10.1016/j.ijrobp.2009.03.010
    OpenUrlCrossRefPubMed
  7. ↵
    1. Parc Y,
    2. Zutshi M,
    3. Zalinski S,
    4. Ruppert R,
    5. Furst A,
    6. Fazio VW
    : Preoperative radiotherapy is associated with worse functional results after coloanal anastomosis for rectal cancer. Dis Colon Rectum 52: 2004-2014, 2009. PMID: 19934922. DOI: 10.1007/DCR.0b013e3181beb4d8
    OpenUrlCrossRefPubMed
  8. ↵
    1. Peeters K,
    2. van de Velde CJH,
    3. Leer JWH,
    4. Martijn H,
    5. Junggeburt JM,
    6. Kranenbarg EK,
    7. Steup WH,
    8. Wiggers T,
    9. Rutten HJ,
    10. Marijnen CA
    : Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: Increased bowel dysfunction in irradiated patients - A dutch colorectal cancer group study. J Clin Oncol 23: 6199-6206, 2005. PMID: 16135487. DOI: 10.1200/JCO.2005.14.779
    OpenUrlAbstract/FREE Full Text
  9. ↵
    1. Marijnen CA,
    2. van de Velde CJ,
    3. Putter H,
    4. van den Brink M,
    5. Maas CP,
    6. Martijn H,
    7. Rutten HJ,
    8. Wiggers T,
    9. Kranenbarg EK,
    10. Leer JW,
    11. Stiggelbout AM
    : Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 23: 1847-1858, 2005. PMID: 15774778. DOI: 10.1200/JCO.2005.05.256
    OpenUrlAbstract/FREE Full Text
  10. ↵
    1. Jorge JM,
    2. Wexner SD
    : Etiology and management of fecal incontinence. Dis Colon Rectum 36: 77-97, 1993. PMID: 8416784. DOI: 10.1007/bf02050307
    OpenUrlCrossRefPubMed
  11. ↵
    1. Vaizey CJ,
    2. Carapeti E,
    3. Cahill JA,
    4. Kamm MA
    : Prospective comparison of faecal incontinence grading systems. Gut 44: 77-80, 1999. PMID: 9862829. DOI: 10.1136/gut.44.1.77
    OpenUrlAbstract/FREE Full Text
  12. ↵
    1. Aaronson NK,
    2. Ahmedzai S,
    3. Bergman B,
    4. Bullinger M,
    5. Cull A,
    6. Duez NJ,
    7. Filiberti A,
    8. Flechtner H,
    9. Fleishman SB,
    10. de Haes JC
    : The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85: 365-376, 1993. PMID: 8433390. DOI: 10.1093/jnci/85.5.365
    OpenUrlCrossRefPubMed
  13. ↵
    1. Kye BH,
    2. Kim HJ,
    3. Kim JG,
    4. Kim SH,
    5. Shim BY,
    6. Lee NS,
    7. Cho HM
    : Short-term effects of neoadjuvant chemoradiation therapy on anorectal function in rectal cancer patients: a pilot study. Radiat Oncol 8: 203, 2013. PMID: 23961877. DOI: 10.1186/1748-717X-8-203
    OpenUrlPubMed
  14. ↵
    1. Ammann K,
    2. Kirchmayr W,
    3. Klaus A,
    4. Mühlmann G,
    5. Kafka R,
    6. Oberwalder M,
    7. De Vries A,
    8. Ofner D,
    9. Weiss H
    : Impact of neoadjuvant chemoradiation on anal sphincter function in patients with carcinoma of the midrectum and low rectum. Arch Surg 138: 257-261, 2003. PMID: 12611569. DOI: 10.1001/archsurg.138.3.257
    OpenUrlCrossRefPubMed
  15. ↵
    1. Ihnat P,
    2. Slivova I,
    3. Tulinsky L,
    4. Ihnat Rudinska L,
    5. Maca J,
    6. Penka I
    : Anorectal dysfunction after laparoscopic low anterior rectal resection for rectal cancer with and without radiotherapy (manometry study). J Surg Oncol 117: 710-716, 2018. PMID: 29094352. DOI: 10.1002/jso.24885
    OpenUrlPubMed
  16. ↵
    1. Heald RJ,
    2. Karanjia ND
    : Results of radical surgery for rectal cancer. World J Surg 16: 848-857, 1992. PMID: 1462619. DOI: 10.1007/bf02066981
    OpenUrlCrossRefPubMed
  17. ↵
    1. Amin MB,
    2. Edge SB,
    3. Greene F,
    4. Byrd DR,
    5. Brookland RK,
    6. Washington MK,
    7. Gershenwald JE,
    8. Compton CC,
    9. Hess KR,
    10. Sullivan DC,
    11. Jessup JM,
    12. Brierley JD,
    13. Gaspar LE,
    14. Schilsky RL,
    15. Balch CM,
    16. Winchester DP,
    17. Asare EA,
    18. Madera M,
    19. Gress DM,
    20. Meyer LR
    : AJCC Cancer Staging Manual. 8th ed. Switzerland: Springer International Publishing, 2018.
  18. ↵
    1. Kiyomatsu T,
    2. Watanabe T,
    3. Muto T,
    4. Nagawa H
    : The 4-portal technique decreases adverse effects in preoperative radiotherapy for advanced rectal cancer: comparison between the 2-portal and the 4-portal techniques. Am J Surg 194: 542-548, 2007. PMID: 17826076. DOI: 10.1016/j.amjsurg.2007.01.030
    OpenUrlCrossRefPubMed
  19. ↵
    1. Ishihara S,
    2. Kawai K,
    3. Tanaka T,
    4. Kiyomatsu T,
    5. Hata K,
    6. Nozawa H,
    7. Morikawa T,
    8. Watanabe T
    : Oncological outcomes of lateral pelvic lymph node metastasis in rectal cancer treated with preoperative chemoradiotherapy. Dis Colon Rectum 60: 469-476, 2017. PMID: 28383446. DOI: 10.1097/DCR.0000000000000752
    OpenUrlPubMed
  20. ↵
    1. Lange MM,
    2. Maas CP,
    3. Marijnen CAM,
    4. Wiggers T,
    5. Rutten HJ,
    6. Kranenbarg EK,
    7. van de Velde CJ
    : Urinary dysfunction after rectal cancer treatment is mainly caused by surgery. Br J Surg 95: 1020-1028, 2008. PMID: 18563786. DOI: 10.1002/bjs.6126
    OpenUrlCrossRefPubMed
  21. ↵
    1. De Nardi P,
    2. Testoni SG,
    3. Corsetti M,
    4. Andreoletti H,
    5. Giollo P,
    6. Passaretti S,
    7. Testoni PA
    : Manometric evaluation of anorectal function in patients treated with neoadjuvant chemoradiotherapy and total mesorectal excision for rectal cancer. Dig Liver Dis 49: 91-97, 2017. PMID: 27720700. DOI: 10.1016/j.dld.2016.09.005
    OpenUrlPubMed
  22. ↵
    1. Gervas P,
    2. Rotholtz N,
    3. Pisano M,
    4. Kaplan E,
    5. Secic M,
    6. Coucke P,
    7. Pikarsky A,
    8. Efron J,
    9. Weiss E,
    10. Wexner S
    : Quantitative short-term study of anal sphincter function after chemoradiation for rectal cancer. Arch Surg 136: 192-196, 2001. PMID: 11177140. DOI: 10.1001/archsurg.136.2.192
    OpenUrlCrossRefPubMed
  23. ↵
    1. Canda AE,
    2. Terzi C,
    3. Gorken IB,
    4. Oztop I,
    5. Sokmen S,
    6. Fuzun M
    : Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients. Int J Colorectal Dis 25: 197-204, 2010. PMID: 19784660. DOI: 10.1007/s00384-009-0807-y
    OpenUrlCrossRefPubMed
  24. ↵
    1. Kushwaha RS,
    2. Hayne D,
    3. Vaizey CJ,
    4. Wrightham E,
    5. Payne H,
    6. Boulos PB
    : Physiologic changes of the anorectum after pelvic radiotherapy for the treatment of prostate and bladder cancer. Dis Colon Rectum 46: 1182-1188, 2003. PMID: 12972961. DOI: 10.1007/s10350-004-6712-0
    OpenUrlCrossRefPubMed
  25. ↵
    1. Jang NY,
    2. Han TJ,
    3. Kang SB,
    4. Kim DW,
    5. Kim IA,
    6. Kim JS
    : The short-term effect of neoadjuvant chemoradiation on anorectal function in low and midrectal cancer: analysis using preoperative manometric data. Dis Colon Rectum 53: 445-449, 2010. PMID: 20305445. DOI: 10.1007/DCR.0b013e3181c38905
    OpenUrlPubMed
  26. ↵
    1. Kitaguchi D,
    2. Nishizawa Y,
    3. Sasaki T,
    4. Tsukada Y,
    5. Ito M
    : Clinical benefit of high resolution anorectal manometry for the evaluation of anal function after intersphincteric resection. Colorectal Dis 21: 335-341, 2018. PMID: 30537066. DOI: 10.1111/codi.14528
    OpenUrlPubMed
  27. ↵
    1. Hirano A,
    2. Koda K,
    3. Kosugi C,
    4. Yamazaki M,
    5. Yasuda H
    : Damage to anal sphincter/levator ani muscles caused by operative procedure in anal sphincter-preserving operation for rectal cancer. Am J Surg 201: 508-513, 2011. PMID: 20883975. DOI: 10.1016/j.amjsurg.2009.12.016
    OpenUrlPubMed
  28. ↵
    1. Hong TS,
    2. Moughan J,
    3. Garofalo MC,
    4. Bendell J,
    5. Berger AC,
    6. Oldenburg NB,
    7. Anne PR,
    8. Perera F,
    9. Lee RJ,
    10. Jabbour SK,
    11. Nowlan A,
    12. DeNittis A,
    13. Crane C
    : NRG Oncology Radiation Therapy Oncology Group 0822: A phase 2 study of preoperative chemoradiation therapy using intensity modulated radiation therapy in combination with capecitabine and oxaliplatin for patients with locally advanced rectal cancer. Int J Radiat Oncol Biol Phys 93: 29-36, 2015. PMID: 26163334. DOI: 10.1016/j.ijrobp.2015.05.005
    OpenUrlPubMed
    1. Birnbaum EH,
    2. Dreznik Z,
    3. Myerson RJ,
    4. Lacey DL,
    5. Fry RD,
    6. Kodner IJ,
    7. Fleshman JW
    : Early effect of external beam radiation therapy on the anal sphincter: a study using anal manometry and transrectal ultrasound. Dis Colon Rectum 35: 757-761, 1992. PMID: 1643999. DOI: 10.1007/bf02050325
    OpenUrlCrossRefPubMed
    1. Pietsch AP,
    2. Fietkau R,
    3. Klautke G,
    4. Foitzik T,
    5. Klar E
    : Effect of neoadjuvant chemoradiation on postoperative fecal continence and anal sphincter function in rectal cancer patients. Int J Colorectal Dis 22: 1311-1317, 2007. PMID: 17497160. DOI: 10.1007/s00384-007-0322-y
    OpenUrlPubMed
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The Influence of Neoadjuvant Chemoradiation for Middle and Lower Rectal Cancer on Anorectal Function
YUGO HIRATA, HIROAKI NOZAWA, KAZUSHIGE KAWAI, KEISUKE HATA, TOSHIAKI TANAKA, TAKESHI NISHIKAWA, KAZUHITO SASAKI, MANABU KANEKO, SHIGENOBU EMOTO, KOJI MURONO, HIROFUMI SONODA, SOICHIRO ISHIHARA
Anticancer Research Apr 2020, 40 (4) 2199-2208; DOI: 10.21873/anticanres.14181

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The Influence of Neoadjuvant Chemoradiation for Middle and Lower Rectal Cancer on Anorectal Function
YUGO HIRATA, HIROAKI NOZAWA, KAZUSHIGE KAWAI, KEISUKE HATA, TOSHIAKI TANAKA, TAKESHI NISHIKAWA, KAZUHITO SASAKI, MANABU KANEKO, SHIGENOBU EMOTO, KOJI MURONO, HIROFUMI SONODA, SOICHIRO ISHIHARA
Anticancer Research Apr 2020, 40 (4) 2199-2208; DOI: 10.21873/anticanres.14181
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Keywords

  • rectal cancer
  • anorectal function
  • chemoradiotherapy
  • neoadjuvant
  • manometry
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