Alterations in anorectal function after anterior resection for cancer of the rectum

Carmona, J. A.; Ortiz, Héctor; Pérez-Cabañas, I

doi:10.1007/bf00300205

Cited by 67 publications

(24 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[16][17][18] The data from the present study, as well as from our previous report,7 suggest that "tumor-specific" mesorectal excision yields results no different from those of total mesorectal excision, but at lesser cost in terms of leakage and death. Such an approach tailors the operation to the tumor, attempting to save as much rectum as possible to achieve good function.…”

Section: Discussionsupporting

confidence: 58%

Surgical Treatment of Adenocarcinoma of the Rectum

et al. 1998

View full text Add to dashboard Cite

ObjectiveThe authors' aim was to determine survival and recurrence rates in patients undergoing resection of rectal cancer achieved by abdominoperineal resection (APR), coloanal anastomosis (CM), and anterior resection (AR) without adjuvant therapy. Summary Background DataThe surgery of rectal cancer is controversial; so, too, is its adjuvant management. Questions such as preoperative versus postoperative radiation versus no radiation are key. An approach in which the entire mesorectum is excised has been proposed as yielding low recurrence rates. MethodsOf 1423 patients with resected rectal cancers, 491 patients were excluded, leaving 932 with a primary adenocarcinoma of the rectum treated at Mayo. Eighty-six percent were resected for cure. Surgery plus adjuvant treatment was performed in 418, surgery alone in 514. These 514 patients are the subject of this review. Among the 514 patients who underwent surgery alone, APR was performed in 169, CM in 19, AR in 272, and other procedures in 54. Eighty-seven percent of patients were operated on with curative intent. The mean follow-up was 5.6 years; follow-up was complete in 92%.APR and CM were performed excising the envelope of rectal mesentery posteriorly and the supporting tissues laterally from the sacral promontory to the pelvic floor. AR was performed using an appropriately wide rectal mesentery resection technique if the tumor was high; if the tumor was in the middle or low rectum, all mesentery was resected. The mean distal margin achieved by AR was 3 ± 2 cm. ResultsMortality was 2% (12 of 514). Anastomotic leaks after AR occurred in 5% (16 of 291) and overall transient urinary retention in 15%. Eleven percent of patients had a wound infection (abdominal and perineal wound, 30-day, purulence, or cellulitis).The local recurrence and 5-year disease-free survival rates were 7% and 78%, respectively, after AR; 6% and 83%, respectively, after CM; and 4% and 80%, respectively, after APR. Patients with stage Ill disease, had a 60% disease-free survival rate. ConclusionsComplete resection of the envelope of supporting tissues about the rectum during APR, CM, and AR when tumors were low in the rectum is associated with low mortality, low morbidity, low local recurrence, and good 5-year survival rates. Appropriate "tumor-specific" mesorectal excision during AR when the tumor is high in the rectum is likewise consistent with a low rate of local recurrence and good long-term survival. However, the overall failure rate of40% in stage Ill disease (which is independent of surgical technique) means that surgical approaches alone are not sufficient to achieve better long-term survival rates.

show abstract

Section: Discussionsupporting

confidence: 58%

Surgical Treatment of Adenocarcinoma of the Rectum

et al. 1998

View full text Add to dashboard Cite

show abstract

“…The current study did not find a significant correlation between the level of the anastomosis and postoperative stool frequency or incontinence. Previous investigations have demonstrated such a correlation, with lower anastomoses being associated with greater [22][23][24] stool frequency and more incontinence.…”

Section: Resultsmentioning

confidence: 88%

The Long-Term Effect of Adjuvant Postoperative Chemoradiotherapy for Rectal Carcinoma on Bowel Function

et al. 1994

View full text Add to dashboard Cite

ObjectiveThe authors assessed the long-term effect of postoperative chemoradiotherapy on bowel function. Summary Background DataAdjuvant postoperative radiation therapy, often combined with chemotherapy, is being used increasingly often for rectal carcinoma. However, the long-term effect of this treatment on bowel function has not been investigated. MethodsThe records were reviewed of all patients undergoing anterior resection for rectal carcinoma 2 to 5 years previously. During this period, patients with Astler-Coller stage B2 or C tumors generally were given postoperative radiation therapy with chemotherapy, whereas those with earlier stage tumors were not. To minimize possible confounding factors that may have been more common in the group receiving chemoradiotherapy and that may affect bowel function, extensive exclusion criteria were used, such as invasion of contiguous organs, local or distant metastases, use of a dysfunctioning stoma, and anastomotic or pelvic complications. One hundred remaining patients were suitable for inclusion in the study and participated in a telephone questionnaire; 41 patients had postoperative chemoradiotherapy, and 59 did not. ResultsThe two groups were well matched for sex, level of anastomosis, and length of follow-up, although the group receiving chemoradiotherapy was slightly younger. The group that had chemoradiotherapy had more bowel movements per day than the group that did not have radiation therapy (median 7 vs. median 2, p < 0.001); the former group had "clustering" of bowel movements more often (42% vs. 3%, p < 0.001), had nighttime movements more often (46% vs. 14%, p < 0.001), had occasional or frequent incontinence more often (39% and 17% vs. 7% and 0%, p < 0.001), wore a pad more often (41% vs. 10%, p < 0.001), and were unable to defer defecation for more than 15 minutes more often (78% vs. 19%, p < 0.001). The group that had chemoradiotherapy also had stool of liquid consistency, used antidiarrheal medications, had perianal skin irritation, were unable to differentiate stool from gas, and needed to defecate again within 30 minutes of a movement significantly more often than the group that did not receive chemoradiotherapy. 676

show abstract

“…Anorectal dysfunctions, including major and minor fecal incontinence, occur frequently after low anterior rectum resections (anterior resection syndrome) as well as after pull-through coloanal anastomosis and other sphincter saving procedures [3]. Minor anorectal dysfunctions are not easily detected clinically, and therefore anorectal motility studies including anorectal manometry and barostat have been widely used for diagnostic purposes [3,9,10].…”

Section: Discussionmentioning

confidence: 99%

Anorectal sphincter function and rectal barostat study in patients following transanal endoscopic microsurgery

Herman

Richter

Wałęga

et al. 2001

Int J Colorectal Dis

123

View full text Add to dashboard Cite

Background and aims: This study evaluated the effect of transanal endoscopic microsurgery (TEM) on anorectal sphincter functions and determined the risk factors for anorectal dysfunctions (including incontinence). Patients and methods: A study group of 33 patients with small, mobile rectal tumors (adenoma and carcinoma) located up to 12 cm from the anal verge underwent anorectal motility studies (using pull-through anorectal manometry and rectal barostat) and endoanal ultrasound prior to surgery and 3 weeks and 6 months after TEM; controls were 20 healthy volunteers. Results: Resting and squeeze anal pressures were reduced 3 weeks after TEM. Resting anal pressure remained reduced 6 months after surgery; the changes were related to low preoperative levels and to the internal anal sphincter defects rather than to the procedure duration or the type of surgery. High-pressure zone length and vector volume were decreased 3 weeks after TEM and restored 6 months later. Rectoanal inhibitory reflex, reflex sphincter contraction, rectoanal pressure gradients, threshold and maximal tolerable volume of rectal sensitivity, and compliance were significantly changed 3 weeks after TEM; only rectal wall compliance remained low at 6 months. The rectoanal inhibitory reflex, reflex sphincter contraction, rectal sensitivity, and compliance were related to the extent and type of excision (partial or full thickness). Anal ultrasound revealed internal anal sphincter defects in 29% of patients studied 3 weeks after TEM. Only 76% of patients were fully continent. Disturbed anorectal function (including partial fecal incontinence) was observed in up to 50% of patients at 3 weeks. Partial and moderate anorectal dysfunction was found in 21% patients 6 months after surgery. The main risk factors of anorectal dysfunctions following TEM included: postoperative internal anal sphincter defects, low preoperative resting anal pressure, disturbed rectoanal coordination, extent (>50% of wall circumference) and the depth (full thickness) of tumor excision. Conclusion: TEM has a relevant but temporary effect on anorectal motility. As a result of TEM procedures 21% of the patients had disturbed anorectal functions, mostly due to the extent or depth of tumor excision (influencing rectal compliance and rectoanal coordination), and to the sphincter defects lowering resting anal pressure. Preoperative anorectal motility studies and anal ultrasound allow the identification of patients with the risk of postoperative anorectal dysfunctions.

show abstract

Alterations in anorectal function after anterior resection for cancer of the rectum

Cited by 67 publications

References 17 publications

Surgical Treatment of Adenocarcinoma of the Rectum

Surgical Treatment of Adenocarcinoma of the Rectum

The Long-Term Effect of Adjuvant Postoperative Chemoradiotherapy for Rectal Carcinoma on Bowel Function

Anorectal sphincter function and rectal barostat study in patients following transanal endoscopic microsurgery

Contact Info

Product

Resources

About