Long-term effects of neoadjuvant chemoradiotherapy followed by sphincter-preserving resection on anal sphincter function in relation to quality of life among locally advanced rectal cancer patients: a cross-sectional analysis

Abstract

BackgroundThere is growing recognition for the consequences of rectal cancer treatment to maintain an adequate functional sphincter in the long-term rather than preserving the anal sphincter itself. This study aims to evaluate long-term effects of neoadjuvant chemoradiotherapy (nCRT) followed by sphincter-preserving resection on anal sphincter function in relation to quality of life (QoL) among locally advanced rectal cancer patients.MethodsTwenty-nine patients treated with nCRT followed by low anterior resection surgery were included in this study. Data on patient demographics, tumor location and symptoms of urgency and fecal soiling were recorded and evaluated with respect to Wexner Fecal Incontinence Scoring Scale, European Organization for Research and Cancer (EORTC) cancer-specific (EORTC QLQ-C30) and colorectal cancer-specific (EORTC QLQ-CR38) questionnaires and anorectal manometrical findings. Correlation of manometrical findings with Wexner Scale, EORTC QLQ-CR38 scores and EORTC QLQ-C30 scores was also evaluated.ResultsMedian follow-up was 45.6 months (ranged 7.5–98 months. Higher scores for incontinence for gas (p = 0.001), liquid (p = 0.048) and solid (p = 0.019) stool, need to wear pad (p = 0.001) and alteration in life style (p = 0.004) in Wexner scale, while lower scores for future perspective (p = 0.010) and higher scores for defecation problems (p = 0.001) in EORTC QLQ-CR38 were noted in patients with than without urgency. Manometrical findings of resting pressure (mmHg) was positively correlated with body image (r = 0.435, p = 0.030) and sexual functioning (r = 0.479, p = 0.011) items of functional scale, while rectal sensory threshold (RST) volume (mL) was positively correlated with defecation problems (r = 0.424, p = 0.031) items of symptom scale in EORTC QLQ-CR38 and negatively correlated with social function domain (r = −0.479, p = 0.024) in EORTC QLQ-C30. RST volume was also positively correlated with Wexner scores including incontinence for liquid stool (r = 0.459, p = 0.024), need to wear pad (r = 0.466, p = 0.022) and alteration in lifestyle (r = 0.425, p = 0.038).ConclusionThe high risk of developing functional anal impairment as well as the systematic registration of not only oncological but also functional and QoL related outcomes seem important in rectal cancer patients in the long-term disease follow-up.

Dutch validation of the low anterior resection syndrome score

“…This is in accordance with all other validation studies of the LARS score . It is already well documented that preoperative (chemo)radiotherapy results in an impaired QoL in patients with rectal cancer .…”

“…This is in accordance with all other validation studies of the LARS score [6][7][8][9]. It is already well documented that preoperative (chemo)radiotherapy results in an impaired QoL in patients with rectal cancer [18][19][20][21][22]. The Dutch version of the LARS score was also able to discriminate between types of surgery (PME vs TME), just as in the English and the consolidated international validations [6,9].…”

What has preoperative radio(chemo)therapy brought to localized rectal cancer patients in terms of perioperative and long‐term outcomes over the past decades? A systematic review and meta‐analysis based on 41,121 patients

“…For rectal cancer patients, surgeons should increase awareness of both oncological as well as long-term functional outcomes. 37 According to our results of PRT/PCRT in terms of perioperative and long-term outcomes, metastases of the primary tumor and postoperative adverse effects were the primary two barriers to an improved OS. Therefore, simplified and optimized therapies which could maintain the present advantages of PRT/PCRT, further improve MFS and decrease adverse effects should be developed.…”

“…Furthermore, our long‐term results emphasize that the risk of anorectal dysfunction after preoperative treatment should be communicated to patients. For rectal cancer patients, surgeons should increase awareness of both oncological as well as long‐term functional outcomes …”

Does external beam radiation therapy to the pelvis portend worse ileal pouch outcomes? An international multi‐institution collaborative study

“…Despite the evidence suggesting no increased risk of postoperative septic complications, there is still concern regarding anticipated long‐term functional outcomes and pouch failure in those receiving EBRT prior to IPAA. This concern is probably extrapolated from literature demonstrating that neoadjuvant EBRT contributes to low anterior resection syndrome and impaired quality of life when performing a low colorectal or coloanal anastomosis for rectal cancer . Interestingly, in the series of nine patients by Wu et al .…”