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Effect of Preoperative Radio(chemo)therapy on Long-term Functional Outcome in Rectal Cancer Patients: A Systematic Review and Meta-analysis

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Preoperative radio(chemo)therapy (pR(C)T) significantly reduces the local recurrence risk and is therefore recommended in stage II/III rectal cancer. However, this multimodal treatment approach may be associated with late adverse effects. To determine the impact of pR(C)T on long-term anorectal, sexual, and urinary function, we performed a systematic review and meta-analysis.

Methods

PubMed, Embase, and the Cochrane Library were systematically searched for studies reporting on long-term functional outcome after rectal cancer resection with pR(C)T. Only studies that reported anorectal, sexual, and/or urinary function after rectal cancer resection in TME-technique with pR(C)T were eligible for inclusion.

Results

Twenty-five studies, including 6,548 patients, were identified. Methodological quality of the eligible studies was low. The majority of studies reported higher rates of anorectal (14/18 studies) and male sexual dysfunction (9/10 studies) after pR(C)T. Few studies examined female sexual dysfunction (n = 4). Meta-analysis revealed that stool incontinence occurred more often in irradiated patients (risk ratio (RR) = 1.67; 95 % confidence interval (CI), 1.36, 2.05; p < 0.0001) and manometric results were significantly worse after pR(C)T (mean resting pressures (weighted mean difference (WMD) = 15.04; 95 % CI, 0.77, 29.31; p = 0.04) and maximum squeeze pressures (WMD = 30.39; 95 % CI, 21.48, 39.3; p < 0.0001)). Meta-analysis of erectile dysfunction revealed no statistical significance (RR = 1.41; 95 % CI, 0.74, 2.72; p = 0.3). Six of eight studies and meta-analysis demonstrated no negative effect of pR(C)T on urinary function (RR = 1.05; 95 % CI, 0.67, 1.65; p = 0.82).

Conclusions

Although quality of studies on long-term functional outcome is limited, current evidence demonstrates that pR(C)T negatively affects anorectal function after TME.

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Funding

This study received no financial support.

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Authors and Affiliations

  1. Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Martin Loos MD, Philipp Quentmeier MD, Ulrich Nitsche MD, Ralf Gertler MD, Helmut Friess MD & Robert Rosenberg MD

  2. Institute of Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

    Tibor Schuster PhD

  3. Department of Surgery, Kantonsspital Baden, Baden, Switzerland

    Andreas Keerl MD, Thomas Kocher MD & Robert Rosenberg MD

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  1. Martin Loos MD
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Correspondence to Martin Loos MD.

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Loos, M., Quentmeier, P., Schuster, T. et al. Effect of Preoperative Radio(chemo)therapy on Long-term Functional Outcome in Rectal Cancer Patients: A Systematic Review and Meta-analysis. Ann Surg Oncol 20, 1816–1828 (2013). https://doi.org/10.1245/s10434-012-2827-z

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  • DOI: https://doi.org/10.1245/s10434-012-2827-z

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