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2012 | 84 | 4 | 177-183
Article title

Low-Anterior-Resection Syndrome. How Does Neoadjuvant Radiotherapy and Low Resection of the Rectum Influence the Function of Anal Sphincters in Patients with Rectal Cancer? Preliminary Results of a Functional Assessment Study

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The aim of the study was to assess the influence of neoadjuvant radiotherapy and resection of the rectum on the functional parameters of anal sphincters.Material and methods. 20 patients with rectal cancer, qualified for low anterior rectal resection with neoadjuvant radiotherapy were enrolled in the study group. The study protocol included an anorectal manometry, electromyography and fecal incontinence questionnaire (FISI) before radiotherapy, after radiotherapy, and after the operation.Results. Of the 20 patients 12 were included in the final analysis, because 8 patients were re-qualified to abdomino-perineal resection of the rectum after neoadjuvant treatment. There were no significant changes in anal pressures assessed 5 to 8 days after radiotherapy. In 3 cases (25%) pathological changes in RAIR reflex were found in the manometric examination. After low anterior resection mean basal anal pressures were significantly lower, whereas squeeze anal pressures did not change significantly. In 7 patients (58%) the RAIR reflex was pathological or even absent after low anterior resection. Changes in manometric parameters correlated with FISI incontinence assessment after the operation. In electromyographic examination action potentials of motoric units of the external anal sphincter were still present both after radiotherapy, and after operation.Conclusions. Fecal incontinence after low anterior resection of the rectum seems to be caused mostly by changes in autonomic functionality of anal sphincters and lack of compliance of the neorectum, since the influence of neoadjuvant radiotherapy and the operation itself on the somatic innervation of anal sphincters seems to be minimal.
Physical description
1 - 4 - 2012
14 - 6 - 2012
  • Dixon CF: Anterior Resection for Malignant Lesions of the Upper Part of the Rectum and Lower Part of the Sigmoid. Ann Surg 1948 Sep; 128(3): 425-42.[Crossref][PubMed]
  • Bruheim K, Guren MG, Skovlund E et al.: Late side effects and quality of life after radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys 2010 Mar 15; 76(4): 1005-11.[Crossref]
  • Ortiz H, Armendariz P: Anterior resection: do the patients perceive any clinical benefit? Int J Colorectal Dis 1996; 11(4): 191-95.[Crossref][PubMed]
  • Sterk P, Shekarriz B, Günter S et al.: Voiding and sexual dysfunction after deep rectal resection and total mesorectal excision: prospective study on 52 patients. Int J Colorectal Dis 2005 Sep; 20(5): 423-27.[Crossref]
  • Maurer CA: Urinary and sexual function after total mesorectal excision. Recent Results Cancer Res 2005; 165: 196-204.
  • Vodusek DB: Anatomy and neurocontrol of the pelvic floor. Digestion 2004; 69(2): 87-92.[PubMed]
  • Shafik A: Neuronal innervation of urethral and anal sphincters: surgical anatomy and clinical implications. Curr Opin Obstet Gynecol 2000 Oct; 12(5): 387-98.[Crossref][PubMed]
  • Rao GN, Drew PJ, Lee PW et al.: Anterior resection syndrome is secondary to sympathetic denervation. Int J Colorectal Dis 1996; 11(5): 250-58.[Crossref]
  • Nowakowski M: Ocena unerwienia zwieraczy odbytu za pomocą wielokanałowej elektromiografii powierzchniowej w aspekcie etiologii nietrzymania stolca. 2007; Ph.D. Dissertation, Jagiellonian University Medical College.
  • Salowka J: Wartość diagnostyczna elektromiografii zwieraczy dla oceny funkcji anorektalnych u chorych po przednich resekcjach odbytnicy. 2008; Ph.D. Dissertation, Jagiellonian University Medical College.
  • Pietsch AP, Fietkau R, Klautke G et al.: Effect of neoadjuvant chemoradiation on postoperative fecal continence and anal sphincter function in rectal cancer patients. Int J Colorectal Dis 2007 Nov; 22(11): 1311-17.[WoS][Crossref]
  • Birgisson H, Påhlman L, Gunnarsson U et al.: Late adverse effects of radiation therapy for rectal cancer - a systematic overview. Acta Oncol 2007; 46(4): 504-16.[WoS][Crossref]
  • Ikeuchi H, Kusunoki M, Shoji Y et al.: Clinicophysiological results after sphincter-saving resection for rectal carcinoma. Int J Colorectal Dis 1996; 11(4): 172-76.[Crossref]
  • Lee SJ, Park YS: Serial evaluation of anorectal function following low anterior resection of the rectum. Int J Colorectal Dis 1998; 13(5-6): 241-46.[PubMed][Crossref]
  • Azpiroz F, Enck P, Whitehead WE: Anorectal functional testing: review of collective experience. Am J Gastroenterol 2002 Feb; 97(2): 232-40.[PubMed]
  • Williamson ME, Lewis WG, Finan PJ et al.: Recovery of physiologic and clinical function after low anterior resection of the rectum for carcinoma: myth or reality? Dis Colon Rectum 1995 Apr; 38(4): 411-18.[Crossref]
  • Lewis WG, Martin IG, Williamson ME et al.: Why do some patients experience poor functional results after anterior resection of the rectum for carcinoma? Dis Colon Rectum 1995 Mar; 38(3): 259-63.[Crossref]
  • Zutshi M, Salcedo L, Hammel J et al.: Anal physiology testing in fecal incontinence: is it of any value? Int J Colorectal Dis 2010 Feb; 25(2): 277-82.[WoS][Crossref]
  • Frenckner B, Ihre T: Influence of autonomic nerves on the internal and sphincter in man. Gut 1976 Apr; 17(4): 306-12.[Crossref][PubMed]
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