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

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

doi:10.1016/j.dld.2016.09.005

Cited by 20 publications

(29 citation statements)

References 47 publications

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“…In this study, change in the MRST immediately after CRT showed a decrease in statistical significance. This finding is in accordance with that in previous studies on anorectal function post-CRT in patients with rectal cancer [11,[16][17][18]. To explain the reduced MRST post-CRT, Song et al [18] investigated the acute inflammation and edema caused by radiation exposure to the rectum.…”

Section: Discussionsupporting

confidence: 89%

“…Several studies reported decline in anorectal function from the multimodal treatment, using different scoring systems and questionnaires as reported by patients [6,8,9]. Although bowel dysfunction after rectal cancer treatment is widely reported, only a limited number of studies with small sample sizes have provided objective data for anorectal function obtained from anorectal manometry [7,10,11]. Herein, this study aims to demonstrate the manometric changes in patients with mid-to low rectal cancer throughout multimodal treatment of preoperative CRT, followed by total mesorectal excision (TME) and evaluate the degree of functional loss by different treatment modalities.…”

Section: Introductionmentioning

confidence: 99%

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The pattern of bowel dysfunction in patients with rectal cancer following the multimodal treatment: anorectal manometric measurements at before and after chemoradiation therapy, and postoperative 1 year

et al. 2023

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Bowel dysfunction commonly occurs in patients with locally advanced rectal cancer treated with a multimodal approach of chemoradiation therapy (CRT) combined with sphincter-preserving rectal resection. This study investigated the decline in anorectal function using sequential anorectal manometric measurements obtained before and after the multimodal treatment as well as at a 1-year follow-up. Methods: This was a retrospective cohort study conducted in a single center. The study population consisted of patients with locally advanced mid-to low rectal cancer who received the preoperative CRT followed by sphincter-preserving surgery from 2012 to 2016. The anorectal manometric value measured after each treatment modality was compared to demonstrate the degree of decline in anorectal function. A generalized linear model of repeated measures was performed using the manometric values measured pre-and post-CRT, and at 12 months postoperatively. Results: Overall, 100 patients with 3 consecutive manometric data were included in the final analysis. In the overall cohort study, the mean resting and maximal squeezing pressures showed insignificant decrement post-neoadjuvant CRT. At a 1-year postoperative follow-up, the maximal squeezing pressure significantly decreased. The maximal rectal sensory threshold demonstrated significant reduction consecutively after each following treatment (P < 0.001). Conclusion: The short-term effect of neoadjuvant CRT on the anal sphincters was relatively trivial. The following sphincter-saving surgery resulted in a profound disruption of the anorectal function. Patients with rectal cancer should be consulted on the consequence of multimodal treatment.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

The pattern of bowel dysfunction in patients with rectal cancer following the multimodal treatment: anorectal manometric measurements at before and after chemoradiation therapy, and postoperative 1 year

et al. 2023

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“…In some studies [ 19 , 20 ], SL increased as in the present study. In terms of pressure profiles, there have been contradictory reports [ 3 , 20 - 22 ]. De Nardi et al [ 22 ] reported that 23% of patients, showed the new onset of anorectal dysfunctions, mostly represented by a lower MRP after PCRT.…”

Section: Discussionmentioning

confidence: 99%

“…In terms of pressure profiles, there have been contradictory reports [ 3 , 20 - 22 ]. De Nardi et al [ 22 ] reported that 23% of patients, showed the new onset of anorectal dysfunctions, mostly represented by a lower MRP after PCRT. They explained that it caused by radiation damage to the internal anal sphincter muscles.…”

Section: Discussionmentioning

confidence: 99%

Peri-treatment change of anorectal function in patients with rectal cancer after preoperative chemoradiotherapy

et al. 2017

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Preoperative chemoradiotherapy (PCRT) is a standard treatment for locally advanced rectal cancer. The influence of PCRT on anorectal function has not been objectively assessed. We evaluated the short-term influence of PCRT on anorectal function in patients with locally advanced rectal cancer using anorectal manometry. We included 310 patients with locally advanced mid and lower rectal cancer who underwent PCRT from 2012 to 2015. We compared anorectal function based on anorectal manometry between before and after PCRT according to tumor location, clinical T (cT) stage, and tumor response after PCRT. Lower rectal cancer was common in the cohort of 310 patients (n = 228, 73.5%). Sphincter length (p = 0.003) and maximal resting pressure (p < 0.001) increased and maximal tolerated volume (p = 0.036) decreased after PCRT regardless of tumor location. Maximal squeezing pressure and rectal compliance slightly decreased, without statistical significance. Changes in manometric parameters after PCRT were not associated with changes of cT stage after PCRT. However, minimal sensory volume (p = 0.042) and maximal tolerated volume (p = 0.025) increased significantly in 143 patients (46.1%) with changes in the distance of the cancer from the anal verge after PCRT. PCRT did not impair the overall short-term anorectal manometric parameters in patients with locally advanced rectal cancer. Further study is required to investigate postoperative anorectal function after sphincter-preserving surgery to evaluate the long-term effects of PCRT on anorectal function.

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“…After rectal resection approximately 60% of patients experience some degree of fecal incontinence (FI). When evaluated by anorectal manometry, significant impairment of both internal and external sphincters, as well as reduced capacity of the neorectum have been demonstrated [21] .…”

Section: Functional Outcome After Tmementioning

confidence: 99%

Functional results and quality of life after transanal total mesorectal excision

Nardi¹

2018

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This is a narrative review on ano-rectal, sexual, urinary, and quality of life outcomes after transanal total mesorectal excision (TME). Little is known on this topic as only a few studies are currently available in the literature. According to these, it appears that the functional results and quality of life are not substantially impaired compared with standard TME. However more data are needed to precisely assess the outcomes of this technique.

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

Cited by 20 publications

References 47 publications

The pattern of bowel dysfunction in patients with rectal cancer following the multimodal treatment: anorectal manometric measurements at before and after chemoradiation therapy, and postoperative 1 year

The pattern of bowel dysfunction in patients with rectal cancer following the multimodal treatment: anorectal manometric measurements at before and after chemoradiation therapy, and postoperative 1 year

Peri-treatment change of anorectal function in patients with rectal cancer after preoperative chemoradiotherapy

Functional results and quality of life after transanal total mesorectal excision

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