Abstract
Neoadjuvant radiochemotherapy (RCTx) has become an acceptable therapy for patients with locally advanced rectal cancer. However, little is known about the effect of the RCTx on the function of the anal sphincter. Forty-one consecutive patients with locally advanced rectal cancer (cT3, N+) underwent neoadjuvant RCTx with subsequent resection. All patients were examined clinically and by anal manometry for their anal sphincter function. A multichannel water-perfused catheter system was used, and resting pressure, maximum squeeze pressure, and length of the anal high-pressure zone were determined prior to the neoadjuvant therapy and before the operation. The length of the high-pressure zone did not change after the neoadjuvant therapy. However, resting and maximum squeeze pressure decreased significantly after preoperative RCTx. This effect was more pronounced for the resting pressure rather than the maximum squeeze pressure, indicating that the internal sphincter is primarily affected. These results correlated with the clinical data showing an impaired continence status in patients treated with neoadjuvant therapy. Neoadjuvant RCTx leads to impairment of the anal sphincter predominantly in the internal sphincter. This effect may enhance the surgical impairment of continence after curative resection.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Minsky BD, Cohen AM, Kemeny N, et al. Enhancement of radiation induced downstaging of rectal cancer by fluorouracil and high-dose leucovorin chemotherapy. J Clin Oncol 1992;10:79–84.
Rödel C, Grabenbauer CG, Schick CH, et al. Preoperative radiation with concurrent 5-FU for locally advanced T4-primary rectal cancer. Strahlenther Onkol 2000;176:161–167.
Videtic GM, Fisher BJ, Perera FE, et al. Preoperative radiation with concurrent 5-FU continuous infusion for locally advanced unresectable cancer. Int J Radiat Oncol Biol Phys 1998;42:319–324.
Grann A, Minsky BD, Cohen AM. Preliminary results of preoperative 5-FU, low dose leucovorin, and concurrent radiation for resectable T3 rectal cancer. Dis Colon Rectum 1997;40:515–522.
Rouanet P, Fabre JM, Dubois JB. Conservative surgery for low rectal carcinoma after high-dose radiation. Ann Surg 1995;221:67–73.
Wagman R, Minsky BD, Cohen AM, et al. Sphincter preservation with preoperative radiation therapy and coloanal anastomosis: Long term follow up. Int J Radiat Oncol Biol Phys 1998;42:51–57.
Pählma L. Neoadjuvant and adjuvant radio- and radiochemotherapy of rectal carcinoma. Int J Colorectal Dis 2000;15:1–8.
Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 1997;336:980–987.
Kapitejin E, Marijnen CAM, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer patients. N Engl J Med 2001;345:638–646.
Sauer R, Fietkau R, Wittekind C, et al. Adjuvant vs. neoadjuvant radiochemotherapy for locally advanced rectal cancer: The German trial CAO/ARO/AIO-94. Colorectal Dis 2003; 5:406–415.
Williamson ME, Lewis WG, Finan PJ, et al. Recovery of physiologic and clinical function after low anterior resection of the rectum for carcinoma. Myth or reality?Dis Col Rectum 1995;38:411–418.
Duijvendijk P, Slors JFM, Taat CW, et al. Prospective evaluation of anorectal function after total mesorectal excision for rectal carcinoma with or without preoperative radiotherapy. Am J Gastroenterol 2002;97:2282–2289.
Rasmussen OO, Pedersen IK, Christiansen J. Anorectal function following low anterior resection. Colorectal Dis 2003;5:258–261.
Pedersen IK, Christiansen J, Hint K. Anorectal function after low anterior resection for carcinoma. Ann Surg 1986;204:133–135.
Kuswaha RS, Hayne D, Vaizey CJ, et al. Physiologic changes of the anorectum after pelvic radiotherapy for the treatment of prostate and bladder cancer. Dis Col Rectum 2003;46:1182–1188.
Yeoh EK, Russo A, Botten R, et al. Acute effects of therapeutic irradiation for prostatic carcinoma on anorectal function. Gut 1998;43:123–127.
Kim GE, Lim JJ, Park W, et al. Sensory and motor dysfunction assessed by anorectal manometry in uterine cervical carcinoma treated patients with radiation induced late rectal complications. Int J Radiat Oncol Biol Phys 1998;41:835–841.
Birnbaum EH, Myerson RJ, Fry RD, et al. Chronic effects of pelvic radiation therapy on anrorectal function. Dis Col Rectum 1994;37:909–915.
Birnbaum EH, Dreznik Z, Myerson RJ, et al. Early effect of external beam radiation therapy on the anal sphincter. Dis Col Rectum 1992;35:757–761.
Iwamoto T, Nakahara S, Mibu R, et al. Effect of radiotherapy on anorectal function in patients with cervical cancer. Dis Col Rectum 1997;40:693–697.
Gervaz PA, Wexner SD, Pemberton JH. Pelvic radiation and anorecta function: Introducing the concept of sphincter preserving radiation therapy. J Am Coll Surg 2002;387–394.
Johnston CJ, Piedboeuf B, Baggs R, et al. Differences in correlation of mRNA gene expression in mice sensitive and resistant to radiation-induced pulmonary fibrosis. Radiat Res 1995;142:197–203.
Wang J, Zheng H, Sung CC, et al. Cellular sources of transformation growth factor beta isoforms in early and chronic radiation enteropathy. Am J Pathol 1998;153:1531–1540.
Richter KK, Langberg CW, Sung CC, et al. Increased transforming growth factor beta immunreactivity is independently associated with chronic injury in both consequential and primary radiation enteropathy. Int J Radiat Oncol Biol Phys 1997;39:187–195.
Broens P, Van Limbergen E, Penninckx F, et al. Clinical and manometric effects of combined external beam radiation and brachytherapy for anal cancer. Int J Colorect Dis 1998;13:68–62
Vordermark D, Sailer M, Flentje M, et al. Curative intent radiation therapy in anal carcinoma: Quality of life and sphincter function. Radiother Oncol 1999;52:239–243.
Yeoh EK, Russo A, Botten R, et al. Chronic effects of therapeutic irradiation for localized prostatic carcinoma on anorectal function. Int J Radiat Oncol Biol Phys 2000;47:915–924.
Olsen NK, Pfeiffer P, Johannsen L, et al. Radiation induced brachial plexopathy: Neurological follow-up in 161 recurrence-free breast cancer patients. Int J Radiat Oncol Biol Phys 1993;26:43–49.
Kusunoki M, Shoji Y, Yanagi H, et al. Anorectal function after preoperative intraluminal brachytherapy and colonic J-pouch anal anastomosis for rectal carcinoma. Br J Surg 1993;80:933–935.
Ho YH, Lee KS, Eu KW, et al. Effects of adjuvant radiotherapy on bowel function and anorectal physiology after low anterior resection for rectal cancer. Tech Coloproctol 2000;4:13–16.
Fichera A, Michelassi F. Long-term prospective assessment of functional results after proctectomy with colonal anastomosis. J Gastrointestinal Surg 2001;5:153–157.
Gervaz P, Rotholtz N, Pisano M, et al. Quantitative shortterm study of anal sphincter function after chemoradiation for rectal cancer. Arch Surg 2001;136:192–196.
Da Silva GM, Berho M, Efron J, et al. Histological analysis of the anal sphincter after radiotherapy. Colorectal Dis 2001; 3:56.
Vaizey CJ, Caraperti E, Cahill JA, et al. Prospective comparison of faecal incontinence grading systems. Gut 1999;44:77–80.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Theisen, J., Kauer, W.K.H., Nekarda, H. et al. Neoadjuvant radiochemotherapy for patients with locally advanced rectal cancer leads to impairment of the anal sphincter. J Gastrointest Surg 10, 309–314 (2006). https://doi.org/10.1016/j.gassur.2005.04.001
Issue Date:
DOI: https://doi.org/10.1016/j.gassur.2005.04.001