Affiliation:
1. Loginov Moscow Clinical Scientific Centre
2. Lopatkin Scientific Research Institute of Urology and Interventional Radiology — branch of the National Medical Research Centre of Radiology
Abstract
The aim of the study was to compare functional results prior to and following neoadjuvant chemoradiation therapy.Materials and methods. An analysis of the functional results of a prospective clinical study was carried out. The study included 90 patients who underwent low anterior rectal resection for cancer of the lower or middle ampullar rectum with T1-4aN0-2M0 using various reconstruction methods.Results and discussion. Group A included 22 patients with J-shaped reservoirs; group B — 30 patients with side-to-end anastomoses; group C — 38 patients with end-to-end anastomoses. Out of the total study group (n = 90), 43 patients underwent neoadjuvant chemoradiotherapy vs. 47 patients without any preoperative treatment. No statistically significant difference was observed in the frequency of applied reconstructive techniques (р = 0.725) and the incidence of postoperative complications (p = 0.103) in the groups with and without neoadjuvant chemoradiotherapy. The baseline scores of the Wexner scale and the results of anorectal manometry in the comparison groups were comparable (p > 0.05). However, upon completion of neoadjuvant chemoradiotherapy and during the period from the moment of surgery up to 12 months after the closure of preventive intestinal stomas, the functional results were less satisfactory in the group of patients having received neoadjuvant chemoradiotherapy (n = 43) with regard to the comparison group (n = 47). Nevertheless, a statistically significant difference in the results was observed from the end of neoadjuvant chemoradiotherapy up to 3 months after closure of the stoma (p <0.05).Conclusions. Neoadjuvant chemoradiation therapy has a negative effect on the function of the anal sphincter, thus requiring concomitant therapy and physiotherapy both at the stages of neoadjuvant chemoradiotherapy and at long intervals after the main surgical stage.
Publisher
Bashkir State Medical University
Subject
General Engineering,Energy Engineering and Power Technology
Reference23 articles.
1. Erygin D.V., Berdov B.A., Nevolskikh A.A., Titova L.N., Smirnova S.G. Neoadjuvant chemoradiotherapy for locally advanced rectal cancer. P.A. Herzen Journal of Oncology = Onkologiya. Zhurnal imeni P.A. Gertsena. 2015;4(1):13–20 (In Russ.). DOI: 10.17116/onkolog20154113-20
2. Pravosudov I.V., Aliyev I.I., Shulepov A.V., Krzhivitsky P.I. Multidisciplinary treatment of rectal cancer: the assessment of clinical and pathologic response for locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy. Pelvic Surgery and Oncology. 2012;(1):7–10 (In Russ.). DOI: 10.17650/2220-3478-2012-0-1-7-10
3. Wawok P., Polkowski W., Richter P., Szczepkowski M., Olędzki J., Wierzbicki R., et al. Preoperative radiotherapy and local excision of rectal cancer: Long-term results of a randomised study. Radiother Oncol. 2018;127(3):396–403. DOI: 10.1016/j.radonc.2018.04.004
4. Ansari N., Solomon M.J., Fisher R.J., Mackay J., Burmeister B., Ackland S., et al. Acute adverse events and postoperative complications in a randomized trial of preoperative short-course radiotherapy versus long-course chemoradiotherapy for T3 adenocarcinoma of the rectum: Trans-Tasman Radiation Oncology Group Trial (TROG 01.04). Ann Surg. 2017;265(5):882–8. DOI: 10.1097/SLA.0000000000001987
5. Magri K.D., Bin F.C., Formiga F.B., Manzione Tda S., Gomes C.M., Candelári Pde A., et al. Impact of neoadjuvant therapy in downstaging of lower rectal adenocarcinoma and the role of pelvic magnetic resonance in staging. Rev Col Bras Cir. 2016;43(2):102–9. DOI: 10.1590/0100-69912016002006