Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1994 Nov;220(5):676–682. doi: 10.1097/00000658-199411000-00012

The long-term effect of adjuvant postoperative chemoradiotherapy for rectal carcinoma on bowel function.

C F Kollmorgen 1, A P Meagher 1, B G Wolff 1, J H Pemberton 1, J A Martenson 1, D M Illstrup 1
PMCID: PMC1234457  PMID: 7979617

Abstract

OBJECTIVE: The authors assessed the long-term effect of postoperative chemoradiotherapy on bowel function. SUMMARY BACKGROUND DATA: Adjuvant postoperative radiation therapy, often combined with chemotherapy, is being used increasingly often for rectal carcinoma. However, the long-term effect of this treatment on bowel function has not been investigated. METHODS: The records were reviewed of all patients undergoing anterior resection for rectal carcinoma 2 to 5 years previously. During this period, patients with Astler-Coller stage B2 or C tumors generally were given postoperative radiation therapy with chemotherapy, whereas those with earlier stage tumors were not. To minimize possible confounding factors that may have been more common in the group receiving chemoradiotherapy and that may affect bowel function, extensive exclusion criteria were used, such as invasion of contiguous organs, local or distant metastases, use of a dysfunctioning stoma, and anastomotic or pelvic complications. One hundred remaining patients were suitable for inclusion in the study and participated in a telephone questionnaire; 41 patients had postoperative chemoradiotherapy, and 59 did not. RESULTS: The two groups were well matched for sex, level of anastomosis, and length of follow-up, although the group receiving chemoradiotherapy was slightly younger. The group that had chemoradiotherapy had more bowel movements per day than the group that did not have radiation therapy (median 7 vs. median 2, p < 0.001); the former group had "clustering" of bowel movements more often (42% vs. 3%, p < 0.001), had nighttime movements more often (46% vs. 14%, p < 0.001), had occasional or frequent incontinence more often (39% and 17% vs. 7% and 0%, p < 0.001), wore a pad more often (41% vs. 10%, p < 0.001), and were unable to defer defecation for more than 15 minutes more often (78% vs. 19%, p < 0.001). The group that had chemoradiotherapy also had stool of liquid consistency, used antidiarrheal medications, had perianal skin irritation, were unable to differentiate stool from gas, and needed to defecate again within 30 minutes of a movement significantly more often than the group that did not receive chemoradiotherapy. CONCLUSION: Adjuvant postoperative chemoradiotherapy for rectal carcinoma has a major long-term detrimental effect on bowel function.

Full text

PDF
676

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Balslev I., Pedersen M., Teglbjaerg P. S., Hanberg-Soerensen F., Bone J., Jacobsen N. O., Overgaard J., Sell A., Bertelsen K., Hage E. Postoperative radiotherapy in Dukes' B and C carcinoma of the rectum and rectosigmoid. A randomized multicenter study. Cancer. 1986 Jul 1;58(1):22–28. doi: 10.1002/1097-0142(19860701)58:1<22::aid-cncr2820580106>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  2. Birnbaum E. H., Dreznik Z., Myerson R. J., Lacey D. L., Fry R. D., Kodner I. J., Fleshman J. W. Early effect of external beam radiation therapy on the anal sphincter: a study using anal manometry and transrectal ultrasound. Dis Colon Rectum. 1992 Aug;35(8):757–761. doi: 10.1007/BF02050325. [DOI] [PubMed] [Google Scholar]
  3. Carmona J. A., Ortiz H., Perez-Cabañas I. Alterations in anorectal function after anterior resection for cancer of the rectum. Int J Colorectal Dis. 1991 May;6(2):108–110. doi: 10.1007/BF00300205. [DOI] [PubMed] [Google Scholar]
  4. Cummings B. J. Adjuvant radiation therapy for colorectal cancer. Cancer. 1992 Sep 1;70(5 Suppl):1372–1383. doi: 10.1002/1097-0142(19920901)70:3+<1372::aid-cncr2820701527>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
  5. Douglass H. O., Jr, Moertel C. G., Mayer R. J., Thomas P. R., Lindblad A. S., Mittleman A., Stablein D. M., Bruckner H. W. Survival after postoperative combination treatment of rectal cancer. N Engl J Med. 1986 Nov 13;315(20):1294–1295. doi: 10.1056/NEJM198611133152014. [DOI] [PubMed] [Google Scholar]
  6. Fain S. N., Patin C. S., Morgenstern L. Use of a mechanical suturing apparatus in low colorectal anastomosis. Arch Surg. 1975 Sep;110(9):1079–1082. doi: 10.1001/archsurg.1975.01360150023004. [DOI] [PubMed] [Google Scholar]
  7. Henriksson R., Franzén L., Littbrand B. Effects of sucralfate on acute and late bowel discomfort following radiotherapy of pelvic cancer. J Clin Oncol. 1992 Jun;10(6):969–975. doi: 10.1200/JCO.1992.10.6.969. [DOI] [PubMed] [Google Scholar]
  8. Hoskins R. B., Gunderson L. L., Dosoretz D. E., Rich T. A., Galdabini J., Donaldson G., Cohen A. M. Adjuvant postoperative radiotherapy in carcinoma of the rectum and rectosigmoid. Cancer. 1985 Jan 1;55(1):61–71. doi: 10.1002/1097-0142(19850101)55:1<61::aid-cncr2820550111>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  9. Hricak H. Postoperative and postradiation changes in the pelvis. Magn Reson Q. 1990 Oct;6(4):276–297. [PubMed] [Google Scholar]
  10. Karanjia N. D., Schache D. J., Heald R. J. Function of the distal rectum after low anterior resection for carcinoma. Br J Surg. 1992 Feb;79(2):114–116. doi: 10.1002/bjs.1800790206. [DOI] [PubMed] [Google Scholar]
  11. Kerman H. D., Roberson S. H., Bloom T. S., Heron H. C., Yaeger T. E., Meese D. L., Ritter A. H., Tolland J. T., Spangler A. E. Rectal carcinoma. Long-term experience with moderately high-dose preoperative radiation and low anterior resection. Cancer. 1992 Jun 1;69(11):2813–2819. doi: 10.1002/1097-0142(19920601)69:11<2813::aid-cncr2820691129>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]
  12. Krook J. E., Moertel C. G., Gunderson L. L., Wieand H. S., Collins R. T., Beart R. W., Kubista T. P., Poon M. A., Meyers W. C., Mailliard J. A. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med. 1991 Mar 14;324(11):709–715. doi: 10.1056/NEJM199103143241101. [DOI] [PubMed] [Google Scholar]
  13. Kusunoki M., Shoji Y., Yanagi H., Kamikonya N., Sakanoue Y., Hishikawa Y., Utsunomiya J. Anorectal function after preoperative intraluminal brachytherapy and colonic J pouch-anal anastomosis for rectal carcinoma. Br J Surg. 1993 Jul;80(7):933–935. doi: 10.1002/bjs.1800800749. [DOI] [PubMed] [Google Scholar]
  14. Lewis W. G., Holdsworth P. J., Stephenson B. M., Finan P. J., Johnston D. Role of the rectum in the physiological and clinical results of coloanal and colorectal anastomosis after anterior resection for rectal carcinoma. Br J Surg. 1992 Oct;79(10):1082–1086. doi: 10.1002/bjs.1800791032. [DOI] [PubMed] [Google Scholar]
  15. MacFarlane J. K., Ryall R. D., Heald R. J. Mesorectal excision for rectal cancer. Lancet. 1993 Feb 20;341(8843):457–460. doi: 10.1016/0140-6736(93)90207-w. [DOI] [PubMed] [Google Scholar]
  16. McDonald P. J., Heald R. J. A survey of postoperative function after rectal anastomosis with circular stapling devices. Br J Surg. 1983 Dec;70(12):727–729. doi: 10.1002/bjs.1800701211. [DOI] [PubMed] [Google Scholar]
  17. Pedersen I. K., Christiansen J., Hint K., Jensen P., Olsen J., Mortensen P. E. Anorectal function after low anterior resection for carcinoma. Ann Surg. 1986 Aug;204(2):133–135. doi: 10.1097/00000658-198608000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Påhlman L., Glimelius B. Pre- or postoperative radiotherapy in rectal and rectosigmoid carcinoma. Report from a randomized multicenter trial. Ann Surg. 1990 Feb;211(2):187–195. doi: 10.1097/00000658-199002000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Suzuki H., Matsumoto K., Amano S., Fujioka M., Honzumi M. Anorectal pressure and rectal compliance after low anterior resection. Br J Surg. 1980 Sep;67(9):655–657. doi: 10.1002/bjs.1800670917. [DOI] [PubMed] [Google Scholar]
  20. Tang R., Wang J. Y., Chen J. S., Chang-Chien C. R., Lin S. E., Leung S., Fan H. A. Postoperative adjuvant radiotherapy in Astler-Coller stages B2 and C rectal cancer. Dis Colon Rectum. 1992 Nov;35(11):1057–1065. doi: 10.1007/BF02252996. [DOI] [PubMed] [Google Scholar]
  21. Trépo C., Zoulim F., Alonso C., Petit M. A., Pichoud C., Vitvitski L. Diagnostic markers of viral hepatitis B and C. Gut. 1993;34(2 Suppl):S20–S25. doi: 10.1136/gut.34.2_suppl.s20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Varma J. S., Smith A. N. Anorectal function following colo-anal sleeve anastomosis for chronic radiation injury to the rectum. Br J Surg. 1986 Apr;73(4):285–289. doi: 10.1002/bjs.1800730413. [DOI] [PubMed] [Google Scholar]
  23. Varma J. S., Smith A. N., Busuttil A. Correlation of clinical and manometric abnormalities of rectal function following chronic radiation injury. Br J Surg. 1985 Nov;72(11):875–878. doi: 10.1002/bjs.1800721107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Varma J. S., Smith A. N., Busuttil A. Function of the anal sphincters after chronic radiation injury. Gut. 1986 May;27(5):528–533. doi: 10.1136/gut.27.5.528. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Williams N. S., Dixon M. F., Johnston D. Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: a study of distal intramural spread and of patients' survival. Br J Surg. 1983 Mar;70(3):150–154. doi: 10.1002/bjs.1800700305. [DOI] [PubMed] [Google Scholar]
  26. Williams N. S., Durdey P., Johnston D. The outcome following sphincter-saving resection and abdominoperineal resection for low rectal cancer. Br J Surg. 1985 Aug;72(8):595–598. doi: 10.1002/bjs.1800720804. [DOI] [PubMed] [Google Scholar]
  27. Williams N. S., Johnston D. The quality of life after rectal excision for low rectal cancer. Br J Surg. 1983 Aug;70(8):460–462. doi: 10.1002/bjs.1800700805. [DOI] [PubMed] [Google Scholar]
  28. Williams N. S., Price R., Johnston D. The long term effect of sphincter preserving operations for rectal carcinoma on function of the anal sphincter in man. Br J Surg. 1980 Mar;67(3):203–208. doi: 10.1002/bjs.1800670313. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES