Effect of Neoadjuvant Chemoradiation on Anorectal Function Assessed with Anorectal Manometry: A Systematic Review and Meta-analysis

Overview

Journal Tumori

Publisher Sage Publications

Specialty Oncology

Date 2024 May 31

PMID 38819198

Authors

Pamela Milito

Guglielmo Niccolo Piozzi

Mohammad Iqbal Hussain

Tommaso A Dragani

Luca Sorrentino

Maurizio Cosimelli

Marcello Guaglio

Luigi Battaglia

Affiliations

Soon will be listed here.

Abstract

Aim: Improvement in oncological survival for rectal cancer increases attention to anorectal dysfunction. Diagnostic questionnaires can evaluate quality of life but are subjective and dependent on patients' compliance. Anorectal manometry can objectively assess the continence mechanism and identify functional sphincter weakness and rectal compliance. Neoadjuvant chemoradiotherapy is presumed to affect anorectal function. We aim to assess anorectal function in rectal cancer patients who undergo total mesorectal excision, with or without neoadjuvant chemoradiation, using anorectal manometry measurements.

Method: MEDLINE, Embase, and Cochrane databases were searched for studies comparing perioperative anorectal manometry between neoadjuvant chemoradiation and upfront surgery for rectal cancers. Primary outcomes were resting pressure, squeeze pressure, sensory threshold volume and maximal tolerable volume.

Results: Eight studies were included in the systematic review, of which seven were included for metanalysis. 155 patients (45.3%) had neoadjuvant chemoradiation before definitive surgery, and 187 (54.6%) underwent upfront surgery. Most patients were male (238 vs. 118). The standardized mean difference of mean resting pressure, mean and maximum squeeze pressure, maximum resting pressure, sensory threshold volume, and maximal tolerable volume favored the upfront surgery group but without statistical significance.

Conclusion: Currently available evidence on anorectal manometry protocols failed to show any statistically significant differences in functional outcomes between neoadjuvant chemoradiation and upfront surgery. Further large-scale prospective studies with standardized neoadjuvant chemoradiation and anorectal manometry protocols are needed to validate these findings.

References

Temple L, Bacik J, Savatta S, Gottesman L, Paty P, Weiser M . The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis Colon Rectum. 2005; 48(7):1353-65. DOI: 10.1007/s10350-004-0942-z. View

Pescatori M, Anastasio G, Bottini C, Mentasti A . New grading and scoring for anal incontinence. Evaluation of 335 patients. Dis Colon Rectum. 1992; 35(5):482-7. DOI: 10.1007/BF02049407. View

Uzcudun A, Batlle J, Velasco J, Sanchez Santos M, de Castro Carpeno J, Grande A . Efficacy of preoperative radiation therapy for resectable rectal adenocarcinoma when combined with oral tegafur-uracil modulated with leucovorin: results from a phase II study. Dis Colon Rectum. 2002; 45(10):1349-58. DOI: 10.1007/s10350-004-6424-5. View

Dulskas A, Samalavicius N . Usefulness of Anorectal Manometry for Diagnosing Continence Problems After a Low Anterior Resection. Ann Coloproctol. 2016; 32(3):101-4. PMC: 4942524. DOI: 10.3393/ac.2016.32.3.101. View

van Duijvendijk P, Slors J, Taat C, van Tets W, van Tienhoven G, Obertop H . Prospective evaluation of anorectal function after total mesorectal excision for rectal carcinoma with or without preoperative radiotherapy. Am J Gastroenterol. 2002; 97(9):2282-9. DOI: 10.1111/j.1572-0241.2002.05782.x. View

Nesbakken A, Nygaard K, Lunde O . Mesorectal excision for rectal cancer: functional outcome after low anterior resection and colorectal anastomosis without a reservoir. Colorectal Dis. 2003; 4(3):172-176. DOI: 10.1046/j.1463-1318.2002.00305.x. View

Farouk R, Duthie G, Lee P, Monson J . Endosonographic evidence of injury to the internal anal sphincter after low anterior resection: long-term follow-up. Dis Colon Rectum. 1998; 41(7):888-91. DOI: 10.1007/BF02235373. View

Gervaz P, Rotholtz N, Pisano M, Kaplan E, Secic M, Coucke P . Quantitative short-term study of anal sphincter function after chemoradiation for rectal cancer. Arch Surg. 2001; 136(2):192-6. DOI: 10.1001/archsurg.136.2.192. View

Bakx R, Doeksen A, Slors J, Bemelman W, van Lanschot J, Boeckxstaens G . Neorectal irritability after short-term preoperative radiotherapy and surgical resection for rectal cancer. Am J Gastroenterol. 2008; 104(1):133-41. DOI: 10.1038/ajg.2008.2. View

10.

Kupsch J, Kuhn M, Matzel K, Zimmer J, Radulova-Mauersberger O, Sims A . To what extent is the low anterior resection syndrome (LARS) associated with quality of life as measured using the EORTC C30 and CR38 quality of life questionnaires?. Int J Colorectal Dis. 2019; 34(4):747-762. DOI: 10.1007/s00384-019-03249-7. View

11.

Higgins J, Thompson S, Deeks J, Altman D . Measuring inconsistency in meta-analyses. BMJ. 2003; 327(7414):557-60. PMC: 192859. DOI: 10.1136/bmj.327.7414.557. View

12.

Bakx R, Sprangers M, Oort F, van Tets W, Bemelman W, Slors J . Development and validation of a colorectal functional outcome questionnaire. Int J Colorectal Dis. 2004; 20(2):126-36. DOI: 10.1007/s00384-004-0638-9. View

13.

Carrington E, Brokjaer A, Craven H, Zarate N, Horrocks E, Palit S . Traditional measures of normal anal sphincter function using high-resolution anorectal manometry (HRAM) in 115 healthy volunteers. Neurogastroenterol Motil. 2014; 26(5):625-35. DOI: 10.1111/nmo.12307. View

14.

Kupsch J, Jackisch T, Matzel K, Zimmer J, Schreiber A, Sims A . Outcome of bowel function following anterior resection for rectal cancer-an analysis using the low anterior resection syndrome (LARS) score. Int J Colorectal Dis. 2018; 33(6):787-798. DOI: 10.1007/s00384-018-3006-x. View

15.

Rockwood T, Church J, Fleshman J, Kane R, Mavrantonis C, Thorson A . Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index. Dis Colon Rectum. 1999; 42(12):1525-32. DOI: 10.1007/BF02236199. View

16.

Jimenez-Gomez L, Espin-Basany E, Trenti L, Marti-Gallostra M, Sanchez-Garcia J, Vallribera-Valls F . Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer. Colorectal Dis. 2017; . DOI: 10.1111/codi.13901. View

17.

Krol R, Smeenk R, van Lin E, Yeoh E, Hopman W . Systematic review: anal and rectal changes after radiotherapy for prostate cancer. Int J Colorectal Dis. 2013; 29(3):273-83. DOI: 10.1007/s00384-013-1784-8. View

18.

Canda A, Terzi C, Gorken I, Oztop I, Sokmen S, Fuzun M . Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients. Int J Colorectal Dis. 2009; 25(2):197-204. DOI: 10.1007/s00384-009-0807-y. View

19.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

20.

Jones M, Post J, Crowell M . High-resolution manometry in the evaluation of anorectal disorders: a simultaneous comparison with water-perfused manometry. Am J Gastroenterol. 2007; 102(4):850-5. DOI: 10.1111/j.1572-0241.2007.01069.x. View