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Effect of Neoadjuvant Systemic Chemotherapy With or Without Chemoradiation on Bowel Function in Rectal Cancer Patients Treated With Total Mesorectal Excision

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Journal of Gastrointestinal Surgery Aims and scope

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Abstract

Background

Neoadjuvant chemoradiation (CRT) impairs bowel function in patients with rectal cancer treated with total mesorectal excision (TME). The impact of other forms of neoadjuvant therapy such as neoadjuvant chemotherapy alone (NC) and induction chemotherapy followed by CRT (total neoadjuvant therapy or TNT) on postoperative bowel function has not been investigated.

Methods

We conducted a retrospective review of 176 rectal cancer patients treated between November 1, 2011, and August 31, 2017. All patients completed the MSKCC Bowel Function Instrument (BFI), a validated bowel function questionnaire, at least 6 months after TME and/or ileostomy reversal. Differences in BFI scores were compared across four groups (surgery alone, CRT, NC, and TNT) and also according to exposure to neoadjuvant RT and neoadjuvant chemotherapy. A multivariable linear regression model was used to evaluate the independent relationship between exposure to neoadjuvant RT or chemotherapy and BFI.

Results

BFI total scores were significantly different between the four groups (p = 0.008). Exposure to RT correlated with worse BFI total scores (p = 0.002), and no differences were found in BFI total score after exposure to neoadjuvant chemotherapy (p = 0.92). In a linear regression model, only exposure to RT (β = − 5.1; 95% CI − 8.9 to − 1.3; p = 0.008) and tumor distance from the anal verge (β = 1.23; 95% CI 0.48 to 1.97; p = 0.001) were significantly correlated with BFI total score.

Conclusion

NC, whether administered alone or added to CRT, does not seem to impair bowel function. These data should be used to counsel rectal cancer patients when discussing neoadjuvant therapy options.

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Change history

  • 24 April 2023

    This article has been updated. All author names have been corrected.

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Funding

NCI grant P30 CA008748

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Authors and Affiliations

  1. Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA

    Felipe Quezada-Diaz, Rosa M. Jimenez-Rodriguez, Emmanouil P. Pappou, J. Joshua Smith, Iris Wei, Jose G. Guillem, Philip B. Paty, Garrett M. Nash, Martin R. Weiser & Julio Garcia-Aguilar

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Sujata Patil

Authors
  1. Felipe Quezada-Diaz
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  2. Rosa M. Jimenez-Rodriguez
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Contributions

Dr. Quezada-Diaz was responsible for the design, data collection, statistical analysis, manuscript writing, and final approval of this version and agrees to be accountable for all aspects of the work. Dr. Jimenez-Rodriguez was responsible for study design, data collection, manuscript writing, and final approval of this version and agrees to be accountable for all aspects of the work. Drs. Pappou and Smith were responsible for study design, manuscript writing, and final approval of this version and agree to be accountable for all aspects of the work. Dr. Patil was responsible for statistical analysis, manuscript writing, and final approval of this version and agrees to be accountable for all aspects of the work. Drs. Wei, Guillem, Paty, Nash, and Weiser were responsible for interpretation of data, manuscript writing, and final approval of this version and agree to be accountable for all aspects of the work. Dr. Garcia-Aguilar was responsible for study design, manuscript writing, and final approval of this version and agrees to be accountable for all aspects of the work.

Corresponding author

Correspondence to Julio Garcia-Aguilar.

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The study was approved by the institutional review board of Memorial Sloan Kettering Cancer Center, and a waiver of informed consent was obtained.

Appendix. MSK Bowel Function Instrument

Appendix. MSK Bowel Function Instrument

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Quezada-Diaz, F., Jimenez-Rodriguez, R.M., Pappou, E.P. et al. Effect of Neoadjuvant Systemic Chemotherapy With or Without Chemoradiation on Bowel Function in Rectal Cancer Patients Treated With Total Mesorectal Excision. J Gastrointest Surg 23, 800–807 (2019). https://doi.org/10.1007/s11605-018-4003-7

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