Functional Outcomes of Patients Treated with Intensive Medications for Bowel and Pain Control for Low-Lying Rectal Cancer Who Received Preoperative Chemoradiotherapy

Abstract

Purpose: The aim of this study was to assess the functional outcomes of patients treated with intensive medications for bowel and pain control for low-lying rectal cancer who received preoperative chemoradiotherapy (CRT). Methods: The inclusion criterion was sphincter-preserving surgery following CRT for T3 middle and low rectal cancer. Postoperative defecation control was conducted using calcium polycarbophil and loperamide, and anal pain control was conducted using oxycodone hydrochloride hydrate. The functional outcomes were determined by an annual questionnaire after stoma closure. Results: Of 64 patients evaluated, 33 were reconstructed using the double stapling technique (DST) and 31 were reconstructed using the intersphincteric resection (ISR) technique. The median Visual Analogue Scale at ISR was improved from 7 to 1.5 at 1 year after surgery. The median Wexner scores were 6.0, 6.0, 5.0 and 5.0 for DST and 14.5, 12.0, 10.0 and 8.0 for ISR for the first 4 years, respectively. The only independent predictor of a poor bowel function (Wexner score >10) according to a multivariate analyses was pelvic infection (OR 3.994, 95% CI 1.235-13.52, p = 0.021), while ISR was not a predictor. Conclusions: Anal pain following ISR can be controlled with oxycodone hydrochloride hydrate therapy. ISR is feasible following CRT for low-lying rectal cancer.

Latest Advances in Intersphincteric Resection for Low Rectal Cancer

“…Regarding the bowel function, the fecal frequency 6 Gastroenterology Research and Practice after rectal surgery is dependent on the liquid stool present after the excretion of solid stool. Dysfunction of the anal sphincter allows the escape of liquid stool and the loss of the reservoir function cannot retain the liquid stool; therefore, the bowel function is presumably improved by solidifying the liquid stool of postoperative patients [100]. The nerve-sparing mesorectal excision helping to preserve the function of the internal sphincter has been recommended for better continence.…”

Treatment of Anal Cancer Pain—A Case Report

“…8 Anal pain from low-lying rectal cancer, in patients who received preoperative chemoradiotherapy and underwent intersphincteric resection technique, was adequately controlled with opioids such as oxycodone. 9 In another study on a patient with advanced rectal cancer with tenesmus and poorly localized perineal pain, unresponsive to morphine and ketorolac, methadone use improved his pain. 10 The most effective method to address pain associated with anal cancer is not known.…”