International Journal of Colorectal Disease

, Volume 25, Issue 2, pp 197–204 | Cite as

Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients

  • Aras Emre CandaEmail author
  • Cem Terzi
  • Ilknur B. Gorken
  • Ilhan Oztop
  • Selman Sokmen
  • Mehmet Fuzun
Original Article



Deterioration of anorectal function after long-course preoperative chemoradiotherapy combined with surgery for rectal cancer is poorly defined. We conducted a prospective study to evaluate the acute and long term effects of preoperative chemoradiotherapy on anorectal function and quality of life of the patients.


There were 26 patients in surgery group and 31 patients in preoperative chemoradiotherapy group. Anorectal function and quality of life of the patients were assessed by anorectal manometry, incontinence score, quality of life questionnaire.


Significant lower resting pressures in both groups and lower maximal squeeze pressures in the preoperative chemoradiotherapy group were observed after postsurgical evaluations compared with the paired pretreatment ones. In the surgery group, both the Wexner continence score, FIQL score, and the rectoscopy score were comparable before and after surgery, whereas significant worsening in the Wexner score was observed in the preoperative chemoradiotherapy group postoperatively (P < 0.01). Significant reduction in anal canal resting pressures and squeeze pressures, Wexner score, and FIQL score were observed immediately after the completion of preoperative chemoradiotherapy. Significant lower maximal squeeze pressures and worsening of the Wexner scores were observed in the preoperative chemoradiotherapy group compared to the surgery group during the postoperative assessments (P < 0.05 and P < 0.01, respectively).


Both total mesorectal excision and preoperative chemoradiotherapy may adversely affect the anorectal function. Careful selection of the patients who will benefit from neoadjuvant therapy and identifying the patients with a high risk of developing functional problems may help to improve functional outcomes for the treatment of rectal cancer.


Rectal cancer Preoperative chemoradiotherapy Anorectal manometry Quality of life 


  1. 1.
    Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740CrossRefPubMedGoogle Scholar
  2. 2.
    Kapiteijn E, Marijnen CA, Nagtegaal ID et al, Dutch Colorectal Cancer Group (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646CrossRefPubMedGoogle Scholar
  3. 3.
    Theodoropoulos G, Wise WE, Padmanabhan A et al (2002) T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival. Dis Colon Rectum 45:895–903CrossRefPubMedGoogle Scholar
  4. 4.
    Wheeler JM, Dodds E, Warren BF et al (2004) Preoperative chemoradiotherapy and total mesorectal excision surgery for locally advanced rectal cancer: correlation with rectal cancer regression grade. Dis Colon Rectum 47:2025–2031CrossRefPubMedGoogle Scholar
  5. 5.
    Terzi C, Canda AE, Sagol O et al (2008) Survivin, p53, and Ki-67 as predictors of histopathologic response in locally advanced rectal cancer treated with preoperative chemoradiotherapy. Int J Colorectal Dis 23:37–45CrossRefPubMedGoogle Scholar
  6. 6.
    Lim JF, Tjandra JJ, Hiscock R, Chao MW, Gibbs P (2006) Preoperative chemoradiation for rectal cancer causes prolonged pudendal nerve terminal motor latency. Dis Colon Rectum 49:12–19CrossRefPubMedGoogle Scholar
  7. 7.
    Frykholm GJ, Glimelius B, Påhlman L (1993) Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and an evaluation of late secondary effects. Dis Colon Rectum 36:564–572CrossRefPubMedGoogle Scholar
  8. 8.
    Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36(1):77–97CrossRefPubMedGoogle Scholar
  9. 9.
    Varma JS, Smith AN, Busuttil A (1985) Correlation of clinical and manometric abnormalities of rectal function following chronic radiation injury. Br J Surg 72(11):875–878CrossRefPubMedGoogle Scholar
  10. 10.
    Rockwood TH, Church JM, Fleshman JW et al (2000) Fecal ıncontinence quality of life scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43:9–16CrossRefPubMedGoogle Scholar
  11. 11.
    Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482CrossRefPubMedGoogle Scholar
  12. 12.
    Wong RK, Tandan V, De Silva S, Figueredo A (2007) Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev 2:CD002102PubMedGoogle Scholar
  13. 13.
    Minsky BD (1997) Adjuvant therapy for rectal cancer—a good first step. N Engl JMed 336:1016–1017CrossRefGoogle Scholar
  14. 14.
    Valentini V, Glimelius B, Minsky BD et al (2005) The multidisciplinary rectal cancer treatment: main convergences, controversial aspects and investigational areas which support the need for a European Consensus. Radiother Oncol 76:241–250CrossRefPubMedGoogle Scholar
  15. 15.
    Pollack J, Holm T, Cedermark B, Holmström B, Mellgren A (2006) Long-term effect of preoperative radiation therapy on anorectal function. Dis Colon Rectum 49:345–352CrossRefPubMedGoogle Scholar
  16. 16.
    Ammann K, Kirchmayr W, Klaus A et al (2003) Impact of neoadjuvant chemoradiation on anal sphincter function in patients with carcinoma of the midrectum and low rectum. Arch Surg 138:257–261CrossRefPubMedGoogle Scholar
  17. 17.
    Da Silva GM, Berho M, Wexner SD et al (2003) Histologic analysis of the irradiated anal sphincter. Dis Colon Rectum 46:1492–1497CrossRefPubMedGoogle Scholar
  18. 18.
    Lundby L, Jensen VJ, Overgaard J, Laurberg S (1997) Long-term colorectal function after postoperative radiotherapy for colorectal cancer. Lancet 350:564CrossRefPubMedGoogle Scholar
  19. 19.
    Kusunoki M, Shoji Y, Yanagi H et al (1993) Anorectal function after preoperative intraluminal brachytherapy and colonic J pouch-anal anastomosis for rectal carcinoma. Br J Surg 80:933–935CrossRefPubMedGoogle Scholar
  20. 20.
    Dahlberg M, Glimelius B, Graf W, Påhlman L (1998) Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study. Dis Colon Rectum 41:543–549CrossRefPubMedGoogle Scholar
  21. 21.
    Murata A, Brown CJ, Raval M, Phang PT (2008) Impact of short-course radiotherapy and low anterior resection on quality of life and bowel function in primary rectal cancer. Am J Surg 195:611–615CrossRefPubMedGoogle Scholar
  22. 22.
    Gervaz P, Rotholtz N, Pisano M et al (2001) Quantitative short-term study of anal sphincter function after chemoradiation for rectal cancer. Arch Surg 136(2):192–196CrossRefPubMedGoogle Scholar
  23. 23.
    Pietsch AP, Fietkau R, Klautke G, Foitzik T, Klar E (2007) Effect of neoadjuvant chemoradiation on postoperative fecal continence and anal sphincter function in rectal cancer patients. Int J Colorectal Dis 22:1311–1317CrossRefPubMedGoogle Scholar
  24. 24.
    Wagman R, Minsky BD, Cohen AM, Guillem JG, Paty PP (1998) Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: long term follow-up. Int J Radiat Oncol Biol Phys 42:51–57PubMedGoogle Scholar
  25. 25.
    Tjandra JJ, Reading DM, McLachlan SA et al (2001) Phase II clinical trial of preoperative combined chemoradiation for T3 and T4 resectable rectal cancer: preliminary results. Dis Colon Rectum 44:1113–1122CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Aras Emre Canda
    • 1
    Email author
  • Cem Terzi
    • 1
  • Ilknur B. Gorken
    • 2
  • Ilhan Oztop
    • 3
  • Selman Sokmen
    • 1
  • Mehmet Fuzun
    • 1
  1. 1.Department of SurgeryDokuz Eylul University School of MedicineIzmirTurkey
  2. 2.Department of Radiation OncologyDokuz Eylul University School of MedicineIzmirTurkey
  3. 3.Department of Medical OncologyDokuz Eylul University School of MedicineIzmirTurkey

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