Neoadjuvant Radiochemotherapy for Patients With Locally Advanced Rectal Cancer Leads to Impairment of the Anal Sphincter

• Published in: Journal of gastrointestinal surgery Vol. 10; no. 2; pp. 309 - 314
• Main Authors: Theisen, Joerg, Kauer, Werner K.-H., Nekarda, Hjalmar, Schmid, Ludwig, Stein, Hubert J., Siewert, Joerg-Ruediger
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2006; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Anal Canal - drug effects; Anal Canal - physiopathology; Anal Canal - radiation effects; anal manometry; Anal sphincter; Antimetabolites, Antineoplastic - therapeutic use; Antineoplastic Agents - therapeutic use; Fecal Incontinence - etiology; Female; Fluorouracil - therapeutic use; Humans; Male; Manometry; Medical disorders; Medical treatment; Middle Aged; Muscle Contraction - physiology; Neoadjuvant Therapy; Pressure; Radiotherapy Dosage; Rectal Neoplasms - drug therapy; Rectal Neoplasms - radiotherapy; Rectal Neoplasms - surgery; Treatment Outcome; neoadjuvant therapy; anal manometry; Anal sphincter
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1016/j.gassur.2005.04.001

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.