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International Journal of Colorectal Disease

Erschienen in:

01.08.2007 | Original Article

Functional results after radiochemotherapy and total mesorectal excision for rectal cancer

verfasst von: C. Coco, V. Valentini, A. Manno, G. Rizzo, M. A. Gambacorta, C. Mattana, A. Verbo, A. Picciocchi

Erschienen in: International Journal of Colorectal Disease | Ausgabe 8/2007

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Abstract

Background and purpose

The aim of this study was to prospectively define and measure evacuation and continence disorders after preoperative radiochemotherapy and total mesorectal excision (TME) for rectal cancer 1 year after surgery.

Materials and methods

We submitted 100 patients, who underwent neoadjuvant treatment and anterior resection with TME from 1996 to 2003, to a questionnaire on postoperative continence and evacuation. Anal sphincter function was further assessed by the Memorial Sloan–Kettering score. Factors influencing anorectal function were examined in univariate and multivariate analysis.

Results

Median evacuation score was 16.12 ± 5.12 (range 0–28). Sensation of incomplete evacuation was reported in 58% of cases, necessity to return to the bathroom <15 min in 37% and inability to evacuate completely <15 min in 35%. Median continence score was 13.7 ± 4.79 (range 0–20). Incontinence to flatus was reported in 46% of cases. Colonic J-pouch allows better evacuation and continence. Continence was also better in absence of postoperative complications. Sphincter function resulted excellent or good in 75% of patients according to the Memorial Sloan–Kettering score.

Conclusions

The most frequent symptoms in our series are the sensation of incomplete evacuation, the incontinence to flatus, and the necessity to return to the bathroom <15 min. Colonic J-pouch warrants a better function. Postoperative complications compromise good functional results.

Abrahamsen JF, Fossa SD (1990) Long-term morbidity after curative radiotherapy for carcinoma of the bladder. A retrospective study. Strahlenther Onkol 166(9):580–583PubMed

Allal AS, Bieri S, Pelloni A, Spataro V, Anchisi S, Ambrosetti P et al (2000) Sphincter-sparing surgery after preoperative radiotherapy for low rectal cancers: feasibility, oncologic results and quality of life outcomes. Br J Cancer 82(6):1131–1137PubMedCrossRef

Batignani G, Monaci I, Ficari F, Tonelli F (1991) What affects continence after anterior resection of the rectum? Dis Colon Rectum 34(4):329–335PubMedCrossRef

Bujko K, Nowacki MP, Kepka L, Oledzki J, Bebenek M, Kry M (2005) Postoperative complications in patients irradiated preoperatively for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs chemoradiation. Colorectal Dis 7:410–16PubMedCrossRef

Bujko K, Nowacki MP, Oledzki J, Sopjlo R, Skoczylas J, Chwalinski M et al (2001) Sphincter preservation after short-term preoperative radiotherapy for low rectal cancer. Acta Oncol 40:593–601PubMedCrossRef

Camilleri-Brennan J, Steele RJC (2002) Objective assessment of morbidity and quality of life after surgery for low rectal cancer. Colorectal Dis 4:61–66PubMedCrossRef

Carmona JA, Ortiz H, Perez-Cabanas I (1991) Alterations in anorectal function after anterior resection for cancer of the rectum. Int J Colorectal Dis 6(2):108–110PubMedCrossRef

Chatwin NAM, Ribordy M, Givel JC (2002) Clinical outcomes and quality of life after low anterior resection for rectal cancer. Eur J Surg 168:297–301PubMedCrossRef

Coia LR, Myerson RJ, Tepper JE (1995) Late effects of radiation therapy on gastrointestinal tract. Int J Radiat Oncol Biol Phys 31:1213–36PubMedCrossRef

10.

Colorectal Cancer Collaborative Group (2001) Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet 358:1291–1304 (M1/8507)CrossRef

11.

Crook J, Esche B, Futter N (1996) Effect of pelvic radiotherapy for prostate cancer on bowel, bladder, and sexual function: the patient’s perspective. Urology 47:387–394PubMedCrossRef

12.

Dahlberg M, Glimelius B, Graf W, Pahlman L (1998) Preoperative irradiation affects functional results after surgery for rectal cancer. Dis Colon Rectum 41(5):543–551PubMedCrossRef

13.

Devlin HB, Plant JA, Griffin N (1971) Aftermath of surgery for anorectal cancer. BMJ 3:413–418PubMedCrossRef

14.

Engel J, Kerr J, Schlesinger-Raab A, Eskel R, Sauer H, Holzel D (2003) Quality of life in rectal cancer: a four-year prospective study. Ann Surg 238(2):203–213PubMed

15.

Fokdal L, Hoyer M, Meldgaard P, von der Maase H (2004) Long-term bladder, colorectal, and sexual functions after radical radiotherapy for urinary bladder cancer. Radiother Oncol 17:139–145CrossRef

16.

Frigell A, Ottander M, Stenbeck H, Pahlman L (1990) Quality of life of patients treated with abdominoperineal resection or anterior resection for rectal carcinoma. Ann Chir Gynaecol 79(1):26–30PubMed

17.

Frykholm GJ, Sintorn K, Montelius A, Yung B, Palman L, Glimelius B (1996) Acute lumbosacral plexopathy during and after preoperative radiotherapy of rectal adenocarcinoma. Radiother Oncol 38 (2):121–130PubMedCrossRef

18.

Gamagami R, Istvan G, Cabarrot P, Liagre A, Chiodasso P, Lazortes F (2000) Faecal continence following partial resection of the anal canal in distal rectal cancer: long-term results after coloanal anastomoses. Surgery 127:291–295PubMedCrossRef

19.

Gambacorta MA, Valentini V, Coco C, Morganti AG, Smaniotto D. Miccichè F et al (2004) Chemoradiation with raltitrexed and oxaliplatin in preoperative treatment of stage II–III resectable rectal cancer: phase I and II studies. Int J Radiat Oncol Biol Phys 60(5):139–48PubMedCrossRef

20.

Gerard A, Buyse M, Nordlinger B, Loygue J, Penet F, Kampf P et al (1988) Preoperative radiotherapy as adjuvant treatment in rectal cancer. Ann Surg 208(5):606–614PubMedCrossRef

21.

Gervaz P, Rotholtz N, Wexner SD, Yeop You S, Saigusa N, Kaplan E et al (2001) Colonic J-pouch function in rectal cancer patients. Impact of adjuvant chemoradiotherapy. Dis Colon Rectum 14(11):1667–1675CrossRef

22.

Gillette EL, Mahler PA, Powers BE, Gillette SM, Vujaskovis Z (1995) Late radiation injury to muscle and peripheral nerves. Int J Radiat Oncol Biol Phys 31(5):1309–1318PubMedCrossRef

23.

Glimelius B, Gronberg H, Jarhult J, Wallgren A, Cavallin-Stahl E (2003) A systematic overview of radiation therapy effects in rectal cancer. Acta Oncol 42:476–492PubMedCrossRef

24.

Graf W, Ekstrom K, Glimelius B, Pahlman L (1996) A pilot study of factors influencing bowel function after colorectal anastomosis. Dis Colon Rectum 39:744–749PubMedCrossRef

25.

Grumann MM, Noack EM, Hoffmann IA, Schlag PM (2001) Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer. Ann Surg 233(2):149–56PubMedCrossRef

26.

Guren MG, Eriksen MT, Wiig JN, Karlsen E, Nesbakken A, Sigurdsson HK et al (2005) Quality of life and functional outcome following anterior or abdominoperineal resection for rectal cancer. EJSO 31:735–42PubMedCrossRef

27.

Hallbook O, Sjodahl R (1996) Anastomotic leakage and functional outcome after anterior resection of the rectum. Br J Surg 83(1):60–62PubMedCrossRef

28.

Hallbook O, Nystrom PO, Sjodahl R (1997) Physiologic characteristics of straight and colonic j-pouch anastomoses after rectal excision for cancer. Dis Colon Rectum 40:332–338PubMedCrossRef

29.

Hallbook O, Pahlman L, Krog M, Wexner ST, Sjiodhal R (1996) Randomized comparison of straight and colonic J-pouch anastomosis after low anterior resection. Ann Surg 224(1):58–65PubMedCrossRef

30.

Harris GJ, Lavery IC, Fazio VW (2001) Function of a colonic J pouch continues to improve with time. Br J Surg 88:1623–27PubMedCrossRef

31.

Heald RJ, Leicester RJ (1981) The low stapled anastomosis. Dis Colon Rectum 24(6):437–444PubMedCrossRef

32.

Henningsohn L, Wijkstrom H, Dickman PW, Bergmark K, Steineck G (2002) Distressful symptoms after radical radiotherapy for urinary bladder cancer. Radiother Oncol 62:215–225PubMedCrossRef

33.

Hida J, Yoshifuji T, Tokoro T, Inowe K, Matsuzaki T, Okuno K et al (2004) Comparison of long- term functional results of colonic J-pouch and straight anastomosis after low anterior resection for rectal cancer: a five year follow-up. Dis Colon Rectum 47:1578–1585PubMedCrossRef

34.

Ho YH, Tan M, Seow-Choen F (1996) Prospective randomized controlled study of clinical function and anorectal physiology after low anterior resection: comparison of straight and colonic j-pouch anastomoses. Br J Surg 83:978–980PubMedCrossRef

35.

Ho YH, Wong J, Goh HS (1993) Level of anastomosis and anorectal manometry in predicting function following anterior resection for adenocarcinoma. Int J Colorectal Dis 8(3):170–174PubMedCrossRef

36.

Horgan PG, O’Connell PR, Shinkwin CA, Kirwan WO (1989) Effect of anterior resection on anal sphincter function. Br J Surg 76:783–786PubMedCrossRef

37.

Ikeuchi H, Kusunoki M, Shoji Y, Yamamur T, Utsonomija J (1996) Clinico-physiological results after sphincter-saving resection for rectal carcinoma. Int J Colorectal Dis 11(4):172–176PubMedCrossRef

38.

Janjan NA, Khoo VS, Abbruzzese J, Pazdur R, Dubrow R, Cleary KR et al (1999) Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M.D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys 44(5):1027–1038PubMedCrossRef

39.

Jess P, Christiansen J, Bech P (2002) Quality of life after anterior resection versus abdominoperineal extirpation for rectal cancer. Scand J Gastroenterol 10:1201–1204CrossRef

40.

Jorge JMN,Wexner SD (1993) Etiology and management of faecal incontinence. Dis Colon Rectum 36(1):77–97CrossRef

41.

Kapiteijn E, Marijnen CAM, Nagtegaal ID, Putter H, Steup WH, Wiggers T et al, for the Dutch Colorectal Cancer Group (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646PubMedCrossRef

42.

Karanjia ND, Schache DJ, Heald RJ (1992) Function of the distal rectum after low anterior resection for carcinoma. Br J Surg 79:114–116PubMedCrossRef

43.

Keighley MRB, Matheson D (1980) Functional results of rectal excision and endo-anal anastomosis. Br J Surg 67:757–761PubMedCrossRef

44.

Lewis WG, Holdsworth PJ, Stephenson BM, Finan PJ Jonston D (1992) Role of the rectum in the physiological and clinical results of coloanal and colorectal anastomosis after anterior resection for rectal carcinoma. Br J Surg 79:1082–1086PubMedCrossRef

45.

Lewis WG, Martin IG, Williamson ME, Stephenson BM, Holdsworth PJ, Finan PJ et al (1995) Why do some patients experience poor functional results after anterior resection of the rectum for carcinoma? Dis Colon Rectum 38(3):259–263PubMedCrossRef

46.

Little DJ, Kuban DA, Levy LB, Zagars GK, Pollack A (2003) Quality of life questionnaire results 2 and 3 years after radiotherapy for prostate cancer in a randomized dose-escalation study. Urology 62:707–713PubMedCrossRef

47.

Luna-Perez P, Rodriguez-Ramirez S, Hernandez Pacheco F, Gutierrez de la Barrera M, Fernandez R, La Bastida S (2003) Anal Sphincter preservation in locally advanced low rectal adenocarcinoma after preoperative chemoradiation therapy and coloanal anastomosis. J Surg Oncol 82:1–9CrossRef

48.

MacDonald LD, Anderson HR (1984) Stigma in patients with colorectal cancer: a community study. J Epidemiol Community Health 38(4):284–290PubMed

49.

Machado M, Nygren J, Goldman S, Ljungqvist O (2003) Similar outcome after colonic pouch and side-to-end anastomosis in low anterior resection for rectal cancer. A prospective randomized trial. Ann Surg 238(2):214–220PubMed

50.

Matzel KE, Bittori B, Gunter K, Stadelmeier U, Hohenberger W (2003) Rectal resection with low anastomosis: functional outcome. Colorectal Dis 5:458–468PubMedCrossRef

51.

Matzel KE, Stadelmaier U, Muehldorfer S, Hohenberger W (1997) Continence after colorectal reconstruction following resection: impact of level of anastomosis. Int J Colorectal Dis 12(2):82–87PubMedCrossRef

52.

McDonald PJ, Heald RJ (1983) A survey of postoperative function after rectal anastomosis with circular stapling devices. Br J Surg 70(12):727–729PubMedCrossRef

53.

Medical Research Council Rectal Cancer Working Party (1996) Randomised trial of surgery alone versus radiotherapy followed by surgery for potentially operable locally advanced rectal cancer. Lancet 348(9042):1605–1610CrossRef

54.

Minsky BC, Cohen AM, Enker WE, Paty P (1995) Sphincter preservation with preoperative radiation therapy and coloanal anastomosis. Int J Radiat Oncol Biol Phys 31:553–559PubMedCrossRef

55.

Molloy RG, Moran KT, Coulter J, Waldron R, Kirwan WO (1992) Mechanism of sphincter impairment following low anterior resection. Dis Colon Rectum 35:462–464PubMedCrossRef

56.

Nesbakken A, Nygaard K, Lunde OC (2002) Mesorectal excision for rectal cancer: functional outcome after low anterior resection and colorectal anastomosis without a reservoir. Colorectal Dis 4:172–176PubMedCrossRef

57.

Nesbakken A, Nygaard K, Lunde OC (2001) Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg 88:400–404PubMedCrossRef

58.

Olagne E, Baulieux J, de La Roche E, Adham M, Berthoux, N, Bourdeix O et al (2000) Functional results of delayed coloanal anastomosis after preoperative radiotherapy for lower third rectal cancer. J Am Coll Surg 194:613–619

59.

Pahlman L, Glimelius B (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish rectal cancer trial. N Engl J Med 336:980–987CrossRef

60.

Parkin DM, Muir CS. Cancer incidence in five continents, Vol. VI. Lyon, IARC Scientific Publications, No. 120, 1992

61.

Paty PB, Enker WE, Cohen AM, Minsky BD, Friedlander-Klar H (1994) Long-term functional results of coloanal anastomosis for rectal cancer. Am J Surg 167:90–95PubMedCrossRef

62.

Ridgway PF, Darzi AW (2003) The role of total mesorectal excision in the management of rectal cancer. Cancer Control 10(3):205–211PubMed

63.

Rullier E, Goffre B, Bonnel C, Zerbib F, Caldly M, Saric J (2001) Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum. Ann Surg 234(5):633–40PubMedCrossRef

64.

Temple LKF, Wong WD, Minsky B (2003) The impact of radiation on functional outcomes in patients with rectal cancer and sphincter preservation. Semin Radiat Oncol 13(4):169–177CrossRef

65.

Valentini V, Coco C, Cellini N, Picciocchi A, Fares C, Rosetto ME et al (2001) Ten years of preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumour response, and sphincter preservation in three consecutive studies. Int J Radiat Oncol Biol Phys 51(2):371–383PubMedCrossRef

66.

Valentini V, Coco C, Cellini N, Picciocchi A, Rosetto ME, Mantini G et al (1999) Preoperative chemoradiation with cisplatin and 5-Fluorouracil for extraperitoneal T3 rectal cancer: acute toxicity, tumour response, sphincter preservation. Int J Radiat Oncol Biol Phys 45(5):1075–1084CrossRef

67.

Van Duijvendijk P, Slors JFM, Taat CV, Van Tets WF, Van Tienoven G, Obertop H et al (2002) Prospective evaluation of anorectal function after total mesorectal excision for rectal carcinoma with or without preoperative radiotherapy. Am J Gastroenterol 97(9):2282–2289PubMedCrossRef

68.

Varma JS, Smith AN, Busuttil A (1985) Correlation of clinical and manometric abnormalities of rectal function following chronic radiation injury. Br J Surg 72:875–878PubMedCrossRef

69.

Von Smitten K, Husa A, Kyllonen L (1986) Long-term results of sigmoidostomy in patients with anorectal malignancy. Acta Chir Scand 152:211–213

70.

Wagman R, Minsky BD, Cohen AM, Guillem JG, Paty PP (1998) Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: long term follow-up. Int J Radiat Oncol Biol Phys 42(1):51–57PubMedCrossRef

71.

Welsh FKS, McFall M, Mitchell G, Miles WFA, Woods WGA (2003) Pre-operative short-course radiotherapy is associated with faecal incontinence after anterior resection. Colorectal Dis 5:563–568PubMedCrossRef

72.

Williams NS, Johnston D (1983) The quality of life after rectal excision for low rectal cancer. Br J Surg 70:460–462PubMedCrossRef

73.

Williams NS, Price R, Johnston D (1980) The long term effect of sphincter preserving operations for rectal carcinoma on function of the anal sphincter in man. Br J Surg 67:203–208PubMedCrossRef

74.

Winawer SJ, Fletcher RH, Miller L, Godlee F, Stolar MH, Mullrow CD et al (1997) Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 112:594–642PubMedCrossRef

75.

Wirsching M, Druner HU, Herrmann G (1975) Results of psychosocial adjustment to long-term colostomy. Psycother Psychosom 26(5):245–256CrossRef

76.

Yeoh E, Sun WM, Russo A, Ibanez L, Orowitz M (1996) A retrospective study of the effects of pelvic irradiation for gynaecological cancer on anorectal function. Int J Radiat Oncol Biol Phys 35(5):1003–1010PubMedCrossRef

77.

Yeoh EEK, Botten R, Russo A, McGowan R, Fraser R, Roos D et al (2000) Chronic effects of therapeutic irradiation for localized prostatic carcinoma on anorectal function. Int J Radiat Oncol Biol Phys 47(4):915–924PubMedCrossRef

Titel: Functional results after radiochemotherapy and total mesorectal excision for rectal cancer
verfasst von: C. Coco
V. Valentini
A. Manno
G. Rizzo
M. A. Gambacorta
C. Mattana
A. Verbo
A. Picciocchi
Publikationsdatum: 01.08.2007
Verlag: Springer-Verlag
Erschienen in: International Journal of Colorectal Disease / Ausgabe 8/2007
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-007-0276-0

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Abstract

Background and purpose

Materials and methods

Results

Conclusions

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