Abstract
PURPOSE: The long-term effect of 4,500 cGy of preoperative radiation on anorectal function has not been prospectively evaluated. METHODS: Anal manometry was performed on 20 patients with rectal carcinoma before and four weeks after receiving 4,500 cGy of external radiotherapy. Four patients underwent proctectomies, three died, and three refused follow-up. Ten patients were available for long-term follow-up and underwent anal manometry at 14 to 42 (average, 35.5) months after initial radiotherapy. RESULTS: No significant difference in mean maximum squeeze or resting pressures was found after radiation therapy. The sphincter profile and minimum sensory threshold were unchanged. The rectoanal inhibitory reflex was present in all patients. Nine patients reported normal anal function. One patient who was incontinent before treatment remained incontinent. CONCLUSION: Preoperative radiation therapy has a minimal chronic effect on anorectal function. Incontinence after sphincter-saving operations for rectal cancer should not be attributed to preoperative radiation therapy.
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References
Hatcher PA, Thomson HJ, Ludgate SN, Small WP, Smith AN. Surgical aspects of intestinal injury due to pelvic radiotherapy. Ann Surg 1984;201:470–5.
Anseline PF, Lavery IC, Fazio VW, Jagelman DG, Weakley FL. Radiation injury of the rectum: evaluation of surgical treatment. Ann Surg 1981;194:716–24.
Birnbaum EH, Dreznik Z, Myerson RJ,et al. Early effect of external beam radiation therapy on the anal sphincter: a study using anal manometry and transrectal ultrasound. Dis Colon Rectum 1992;35:757–61.
Montana GS, Fowler WC. Carcinoma of the cervix: analysis of bladder and rectal radiation dose and complications. Int J Radiat Oncol Biol Phys 1989;16:95–100.
Mameghan H, Fisher R, Mameghan J, Watt WH, Tynan A. Bowel complications after radiotherapy for carcinoma of the prostate: the volume effect. Int J Radiat Oncol Biol Phys 1990;18:315–20.
Kimose H-H, Fischer L, Spjeldnaes N, Wara P. Late radiation injury of the colon and rectum: surgical management and outcome. Dis Colon Rectum 1989;32:684–9.
Batignani G, Monaci I, Ficari F, Tonelli F. What affects continence after anterior resection of the rectum? Dis Colon Rectum 1991;34:329–35.
Nakahara S, Itoh H, Mibu R,et al. Clinical and manometric evaluation of anorectal function following low anterior resection with low anastomotic line using an EEATM stapler for rectal cancer. Dis Colon Rectum 1988;31:762–6.
Williams NS, Price R, Johnston D. The long-term effect of sphincter preserving operations for rectal carcinoma on function of the anal sphincter in man. Br J Surg 1980;67:203–8.
O'Riordain MG, Molloy RG, Gillen P, Horgan A, Kirwan WO. Rectoanal inhibitory reflex following low stapled anterior resection of the rectum. Dis Colon Rectum 1992;35:874–8.
Horgan PG, O'Connell PR, Shinkwin CA, Kirwan WO. Effect of anterior resection on anal sphincter function. Br J Surg 1989;76:784–6.
Pedersen BK, Hint K, Olsen J, Christiansen J, Jensen P, Mortensen PE. Anorectal function after low anterior resection for carcinoma. Ann Surg 1986;204:133–5.
Lane RHS, Parks AG. Function of the anal sphincter following colo-anal anastomosis. Br J Surg 1977;64:596–9.
Suzuki H, Matsumoto K, Amano S, Fujioka M, Honzumi M. Anorectal pressure and rectal compliance after low anterior resection. Br J Surg 1980;67:655–7.
Varma JS, Smith AN, Busuttil A. Correlation of clinical and manometric abnormalities of rectal function following chronic radiation injury. Br J Surg 1985;72:875–8.
Sandeman TF. Radiation injury of the anorectal region. Aust N Z J Surg 1980;50:169–72.
Varma JS, Smith AN, Busuttil A. Function of the anal sphincters after chronic radiation injury. Gut 1986;27:528–33.
Varma JS, Smith AN. Anorectal function following coloanal sleeve anastomosis for chronic radiation injury to the rectum. Br J Surg 1986;73:285–9.
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Birnbaum, E.H., Myerson, R.J., Fry, R.D. et al. Chronic effects of pelvic radiation therapy on anorectal function. Dis Colon Rectum 37, 909–915 (1994). https://doi.org/10.1007/BF02052597
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DOI: https://doi.org/10.1007/BF02052597