Please use this identifier to cite or link to this item: http://hdl.handle.net/11434/928
Title: Preoperative chemoradiation for rectal cancer causes prolonged pudendal nerve terminal motor latency.
Epworth Authors: Lim, Jit
Tjandra, Joe
Other Authors: Hiscock, Richard
Chao, Michael
Gibbs, Peter
Keywords: Rectal Cancer
Preoperative Chemoradiation
Pudendal Neuropathy
Fecal Incontinence
Anorectal Function
Pudendal Nerve
Pelvic Floor
5-Fluorouracil
Leucovorin
Radiotherapy
Wexner Continence Score
Anal Pressures
Wexner Score
General Surgery and Gastroenterology Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Jan-2006
Publisher: Springer Nature
Citation: Dis Colon Rectum. 2006 Jan;49(1):12-9.
Abstract: PURPOSE: A worsened anorectal function after chemoradiation for high-risk rectal cancer is often attributed to radiation damage of the anorectum and pelvic floor. Its impact on pudendal nerve function is unclear. This prospective study evaluated the short-term effect of preoperative combined chemoradiation on anorectal physiologic and pudendal nerve function. METHODS: Sixty-six patients (39 men, 27 women) with localized resectable (T3, T4, or N1) rectal cancer were included in the study. All patients received 45 Gy (1.8 Gy/day in 25 fractions) over five weeks, plus 5-fluorouracil (350 mg/m2/day) and leucovorin (20 mg/m2/day) concurrently on days 1 to 5 and 29 to 33. Patients who had rectal cancer with a distal margin within 6 cm of the anal verge had the anus included in the field of radiotherapy (Group A, n = 26). Patients who had rectal cancer with a distal margin 6 to 12 cm from the anal verge had shielding of the anus during radiotherapy (Group B, n = 40). The Wexner continence score, anorectal manometry and pudendal nerve terminal motor latency were assessed at baseline and four weeks after completion of chemo-radiation. RESULTS: The median Wexner score deteriorated significantly (P < 0.0001) from 0 to 2.5 for both Groups A (range, 0-8) and B (range, 0-14). The maximum resting anal pressures were unchanged after chemoradiation. The maximum squeeze anal pressures were reduced (mean = 166.5-157.5 mmHg) after chemoradiation. This change was similar in both Groups A and B. Eighteen patients (Group A = 7, Group B = 11) developed prolonged pudendal nerve terminal motor latency after chemoradiation. These 18 patients similarly had a worsened median Wexner continence score (range, 0-3) and maximum squeeze anal pressures (mean = 165.5-144 mmHg). The results obtained were independent of tumor response to chemo-radiation. CONCLUSIONS: Preoperative chemoradiation for rectal cancer carries a significant risk of pudendal neuropathy, which might contribute to the incidence of fecal incontinence after restorative proctectomy for rectal cancer.
URI: http://hdl.handle.net/11434/928
DOI: 10.1007/s10350-005-0221-7
PubMed URL: https://www.ncbi.nlm.nih.gov/pubmed/16292664
ISSN: 0012-3706
1530-0358
Journal Title: Diseases of the Colon & Rectum
Type: Journal Article
Affiliated Organisations: Department of Colorectal Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
Type of Clinical Study or Trial: Comparative Study
Appears in Collections:Cancer Services
General Surgery and Gastroenterology
Radiation Oncology

Files in This Item:
There are no files associated with this item.


Items in EKB are protected by copyright, with all rights reserved, unless otherwise indicated.