Effects of Preoperative Radiotherapy on Long-Term Bowel Function in Patients With Rectal Cancer Treated With Anterior Resection: A Systematic Review and Meta-analysis

Abstract

Background: Anterior resection is a common surgical approach used in rectal cancer surgery; however, this procedure is known to cause bowel injury and dysfunction. Neoadjuvant therapy is widely used in patients with locally advanced rectal cancer. In this study, we determined the effect of preoperative radiotherapy on long-term bowel function in patients who underwent anterior resection for treatment of rectal cancer. Methods: We performed a comprehensive literature search of the PubMed, Embase, Web of Science, and the Cochrane Library databases. A random-effects model was used in the meta-analysis by the Review Manager software, version 5.3. Results: This systematic review and meta-analysis included 12 studies, which used low anterior resection syndrome score with a total of 2349 patients. Based on them, we concluded that low anterior resection syndrome was significantly more common in the preoperative radiotherapy group (odds ratio 3.59, 95% confidence interval 2.68-4.81, P < .00001) and that major low anterior resection syndrome also occurred significantly more frequently in the preoperative radiotherapy group (odds ratio 3.28, 95% confidence interval 2.05-5.26, P < .00001). Subgroup analyses of long-course radiation, total mesorectal excision, and non-metastatic tumors were performed, and the results met the conclusions of the primary outcomes. Conclusions: Preoperative radiotherapy negatively affects long-term bowel function in patients who undergo anterior resection for rectal cancer.

Predicting bowel function after diverting stoma closure in patients with rectal cancer

“…Patients with diverting stomas should benefit from the model, according to DCA. The predictive factors included in the model were reported in previous literature, such as the interval between the creation and stoma closure, neoadjuvant therapy, anastomotic height, age, sex, and BMI ( 40 - 42 ). In addition, our model identified several pre-operative variables that were significantly associated with post-operative bowel function recovery.…”

Neoadjuvant treatment of colorectal cancer: comprehensive review

“…One of the major proposed benefits of NOM is the avoidance of the surgical morbidity of major rectal resection and its longer-term sequelae on functional and quality-of-life outcomes. Pelvic radiotherapy is recognized to be an independent risk factor for surgical complications, namely anastomotic leak, and for poor postoperative function following surgery, including low anterior resection syndrome (LARS) and urinary and sexual dysfunction 72–75 . Although improvements in radiotherapy techniques may reduce toxicities, understanding the impact of pelvic radiotherapy alone within the context of NOM is essential to facilitate shared decision-making with patients, balancing oncological and functional outcomes, as well as overall quality of life.…”