Dr Pascal Gervaz

Chirurgien FMH, chirurgie interne & chirurgie viscérale

 

 

Quantitative Short-term Study of Anal Sphincter Function After Chemoradiation for Rectal Cancer

 

 

 

by Gervaz P, Rotholtz N, Pisano M, Kaplan E, Secic M, Coucke P, Pikarsky A, Efron J, Weiss E, Wexner S.

 

 

Abstract

Hypothesis

Pelvic irradiation adversely affects anal sphincter function after proctectomy with coloanal anastomosis for low rectal and middle rectal (<10 cm from the anal verge) tumors.

 

Design

Case-control study.

 

Setting

Private, tertiary care referral center.

 

Patients

Patients treated for low rectal adenocarcinoma between January 1, 1994, and October 31, 1999.

 

Interventions

Anal manometric data were prospectively collected at the time of initial diagnosis and before ileostomy closure.

 

Main Outcome Measures

Mean and maximum resting pressures (RPs) and squeeze pressures, threshold volume for sensation, and maximal tolerable volume.

 

Results

Twenty-three patients in the surgery group and 19 in the chemoradiotherapy group were considered for analysis; 15 patients had preoperative radiotherapy and 4 had postoperative radiotherapy. At the time of ileostomy closure, RPs were significantly lower in the chemoradiotherapy group than in the surgery group (32.7 +/- 17 vs 45.3 +/- 18 mm Hg; P =.03). Squeeze pressures were not significantly different between the surgery and chemoradiotherapy groups (108.7 +/- 56.7 vs 102.0 +/- 52.6 mm Hg; P =.69). The ratios of postresection to preresection RPs were also significantly lower in the chemoradiotherapy group (0.49 +/- 0.29) than in the surgery group (0.76 +/- 0.22) (P =.005). Eight to 12 weeks after proctectomy with coloanal anastomosis, a 24% decrease in RP was noted in the surgery group. The addition of adjuvant pelvic irradiation decreased RP by another 27%.

 

Conclusion

Adequate shielding of the anal sphincter should be performed for low rectal cancers whenever a sphincter-preserving procedure is considered.


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The full text of this article can be downloaded here

 

 

 

 

in Archives of Surgery 2001 Feb; 136(2): 192-6.