Abstract
The aim of this study was to try to gauge the functional effect of post-operative adjuvant radiotherapy after potentially curative anterior resection for carcinoma of the rectum. Anorectal function was studied both in the laboratory and clinically in 59 patients, a median of 12 months (range 6–96) after operation. Nine patients received post-operative radiotherapy and 50 matched patients were treated by surgery alone. Though maximum resting anal pressures and maximum squeeze pressures were similar in the two groups of patients, the length and pressure profile of the anal sphincter were both markedly abnormal after radiotherapy. The capacity and compliance of the neorectum were diminished significantly after radiotherapy (maximum tolerated volume 53 ml vs 110 ml after surgery alone, P=0.008, compliance 1.5 ml/cm H2O vs 3.7 ml/cm H2O after surgery alone, p-0.018) and the amount of distension of the neorectum required to produced maximum inhibition of the anal sphincter during the rectoanal inhibitory reflex was also significantly diminished after radiotherapy (P=0.005). Clinical anorectal function was worse among patients who had received radiotherapy, a greater proportion of whom experienced both urgency of defaecation and varying degrees of incontinence. Major faecal leakage necessitating the use of a pad was recorded in 3 of the 59 patients after radiotherapy (one of whom required a permanent colostomy), but in only 5 of 50 patients after surgery alone.
Résumé
Le but de cette étude est d'évaluer les effets fonctionnels d'une radiothérapie adjuvante post-opératoire résection curative d'un cancer du rectum. La function anorectale a été étudiée à la fois en laboratoire et cliniquement chez 59 patients en moyenne 12 mois (de 6 à 96) aprés l'opération. Neuf patients ont reçu une radiothérapie postopératoire et 50 patients comparatifs ont été traités par la chirurgie seule. Alors que la pression de repos maximale et la pression de contraction maximale était similaire chez les deux groupes de patients, la longueur et le profil de pression du canal anal étaient nettement modifiés après la radiothérapie. La capacité et la compliance du néo-rectum étaient significativement diminuées après radiothérapie (volume maximal tolérable de 53 ml vs 110 ml après chirurgie seule, P=0.008, compliance 1,5 ml/cm H2O vs 3,7 ml/cm H2O après chirurgie seule, P=0.018). La distension du néo-rectum nécessaire afin d'entraîner une inhibition maximale du réflexe recto-anal inhibiteur était diminuée significativement après radiothérapie (P=0.05). La fonction ano-rectale clinique était également plus mauvaise chez des patients qui avaient reçu de la radiothérapie, un plus grand nombre d'entre eux se plaignant d'urgency et de degrés variables d'incontinence. Des incontinences fécales majeures nécessitant le port d'une graniture ont été observées chez 3 des 9 patients après radiothérapie (l'un de ceux-ci nécessitant une colostomie permanente) mais chez seulement 5 des 50 patients traités par chirurgie seule.
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Lewis, W.G., Williamson, M.E.R., Kuzu, A. et al. Potential disadvantages of post-operative adjuvant radiotherapy after anterior resection for rectal cancer: a pilot study of sphincter function, rectal capacity and clinical outcome. Int J Colorect Dis 10, 133–137 (1995). https://doi.org/10.1007/BF00298533
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DOI: https://doi.org/10.1007/BF00298533