Manometric evaluation of anorectal function in patients treated with neoadjuvant chemoradiotherapy and total mesorectal excision for rectal cancer

De Nardi, Paola; Testoni, Sabrina Gloria Giulia; Corsetti, Maura; Andreoletti, Hulda; Giollo, Patrizia; Passarett, Sandro; Testoni, Pier Alberto

Abstract

BACKGROUND: An altered anorectal function is reported after chemoradiotherapy (CRT) and surgery for rectal cancer.
AIM: The aim of this study was to clarify the relative contribution of neoadjuvant chemoradiation and surgical resection on the impairment of anorectal function as evaluated by anorectal manometry.
METHODS: Thirty-nine patients with rectal cancer, who underwent neoadjuvant CRT and laparoscopic rectal resection, were evaluated with the Pescatori Faecal Incontinence score, and with anorectal manometry: before neoadjuvant therapy (T0), after neoadjuvant therapy and before surgery (T1), 12 months after stoma closure (T2).
RESULTS: Resting and/or maximum squeeze pressure and/or volume thresholds for urgency were below the normal values in 12 (30%) patients at baseline. After CRT the mean resting pressure significantly decreased (p=0.007). Surgery determined a significantly decrease of the resting pressure (p=0.001), of the maximum squeeze pressure (p=0.001) and of the volume threshold for urgency (p=0.001). Impairment of continence was reported by 5, 11 and 18 patients at T0, T1 and T2, with a mean incontinence score of 3, 3.8 and 3.9 respectively.
CONCLUSIONS: CRT is detrimental to the function of the internal anal sphincter. Rectal resection significantly affects both internal and external anal sphincter function and the maximum tolerated volume of the neo-rectum, particularly in patients with low rectal cancer, significantly impairing anal continence.

Citation

De Nardi, P., Testoni, S. G. G., Corsetti, M., Andreoletti, H., Giollo, P., Passarett, S., & Testoni, P. A. (2017). Manometric evaluation of anorectal function in patients treated with neoadjuvant chemoradiotherapy and total mesorectal excision for rectal cancer. Digestive Diseases and Sciences, 49(1), https://doi.org/10.1016/j.dld.2016.09.005

• Journal Article Type: Article
• Acceptance Date: Sep 14, 2016
• Online Publication Date: Sep 22, 2016
• Publication Date: Jan 3, 2017
• Deposit Date: Apr 13, 2017
• Publicly Available Date: Apr 13, 2017
• Journal: Digestive Diseases and Sciences
• Print ISSN: 0163-2116
• Electronic ISSN: 1573-2568
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 49
• Issue: 1
• DOI: https://doi.org/10.1016/j.dld.2016.09.005
• Keywords: Anorectal function; Chemoradiotherapy; Faecal incontinence; Manometry; Rectal cancer
• Public URL: https://nottingham-repository.worktribe.com/output/842127
• Publisher URL: http://www.sciencedirect.com/science/article/pii/S1590865816307356
• Contract Date: Apr 13, 2017