Long-term anorectal function in rectal cancer patients treated with chemoradiotherapy and endorectal brachytherapy

Pia Møller Faaborg*, Susanne Haas, Donghua Liao, John Ploen, Anders Jakobsen, Hans Bjarke Rahr, Soeren Laurberg, Hans Gregersen, Lilli Lundby, Peter Christensen, Klaus Krogh

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Aim: The aim was to study anorectal function in long-term survivors after combined, curatively intended, chemoradiotherapy and endorectal brachytherapy for low rectal cancer. Methods: This was a case–control design. We compared anorectal function by anal manometry, anal functional lumen imaging probe (EndoFLIP) and rectal bag distension in rectal cancer patients (RCPs) and healthy, normal subjects (NSs). Symptoms were assessed by the low anterior resection syndrome (LARS) and Wexner faecal incontinence scores. Results: Thirteen RCPs (12 men, median age 68 years, range 52–92) after 60 Gy radiotherapy, 5 Gy endorectal brachytherapy and oral tegafur-uracil with complete clinical response (median time since treatment 2.8 years, range 2.2–5.6) were compared to 15 NSs (14 men, median age 64 years, range 47–75). RCPs had lower than normal anal resting pressure, 38.6 mmHg (range 8.8–67.7) versus 58.8 mmHg (25.7–105.2) (P < 0.003), and squeeze pressure, 117 mmHg (55.2–203) versus 188 mmHg (103–248) (P < 0.01). Squeeze-induced pressure increase recorded by EndoFLIP was also lower in RCPs (q > 7.56, P < 0.001) as was the anal canal resistance to increasing distension (q = 3.13, P < 0.05). No differences in median rectal volume at first sensation (72 [22–158] vs. 82 [36–190] ml, P = 0.4) or at urge to defaecate (107 [42–227] vs. 132 [59–334] ml, P = 0.2) were found. However, maximum tolerable rectal volume was lower in RCPs (145 [59–319] vs. 222 [106–447] ml, P < 0.02). The median (range) low anterior resection syndrome score was 27 (0–39) for RCPs and 7 (0–23) for NSs (P < 0.001), while the Wexner score was 0 (0–5) versus 0 (0–4) (P = 0.56). Conclusion: Radiotherapy combined with endorectal brachytherapy for rectal cancer causes long-term anorectal symptoms, impaired anal sphincter function and reduced rectal capacity.

Original languageEnglish
JournalColorectal Disease
Volume23
Issue number9
Pages (from-to)2311-2319
ISSN1462-8910
DOIs
Publication statusPublished - Sep 2021

Bibliographical note

Publisher Copyright:
© 2021 The Association of Coloproctology of Great Britain and Ireland

Keywords

  • chemoradiotherapy
  • functional outcome
  • rectal cancer
  • watch and wait

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