Journal Article

Effect of Preoperative Radio(chemo)therapy on Long-term Functional Outcome in Rectal Cancer Patients: A Systematic Review and Meta-analysis

Gertler, Ralf, Friess, Helmut, Kocher, Thomas, Schuster, Tibor, Keerl, Andreas, Quentmeier, Philipp, Nitsche, Ulrich, Loos, Martin, Rosenberg, Robert

2013

Overview

Background Preoperative radio(chemo)therapy (pR(C)T) significantly reduces the local recurrence risk and is therefore recommended in stage II/III rectal cancer. However, this multimodal treatment approach may be associated with late adverse effects. To determine the impact of pR(C)T on long-term anorectal, sexual, and urinary function, we performed a systematic review and meta-analysis. Methods PubMed, Embase, and the Cochrane Library were systematically searched for studies reporting on long-term functional outcome after rectal cancer resection with pR(C)T. Only studies that reported anorectal, sexual, and/or urinary function after rectal cancer resection in TME-technique with pR(C)T were eligible for inclusion. Results Twenty-five studies, including 6,548 patients, were identified. Methodological quality of the eligible studies was low. The majority of studies reported higher rates of anorectal (14/18 studies) and male sexual dysfunction (9/10 studies) after pR(C)T. Few studies examined female sexual dysfunction ( n  = 4). Meta-analysis revealed that stool incontinence occurred more often in irradiated patients (risk ratio (RR) = 1.67; 95 % confidence interval (CI), 1.36, 2.05; p  < 0.0001) and manometric results were significantly worse after pR(C)T (mean resting pressures (weighted mean difference (WMD) = 15.04; 95 % CI, 0.77, 29.31; p  = 0.04) and maximum squeeze pressures (WMD = 30.39; 95 % CI, 21.48, 39.3; p  < 0.0001)). Meta-analysis of erectile dysfunction revealed no statistical significance (RR = 1.41; 95 % CI, 0.74, 2.72; p  = 0.3). Six of eight studies and meta-analysis demonstrated no negative effect of pR(C)T on urinary function (RR = 1.05; 95 % CI, 0.67, 1.65; p  = 0.82). Conclusions Although quality of studies on long-term functional outcome is limited, current evidence demonstrates that pR(C)T negatively affects anorectal function after TME.

• Publisher: Springer-Verlag,Springer Nature B.V
• Subject: Anal Canal - physiopathology / Chemoradiotherapy, Adjuvant / Colorectal Cancer / Confidence Intervals / Fecal Incontinence - etiology / Humans / Manometry / Medicine / Medicine & Public Health / Neoadjuvant Therapy - adverse effects / Oncology / Rectal Neoplasms - surgery / Rectal Neoplasms - therapy / Sexual Dysfunction, Physiological - etiology / Surgery / Surgical Oncology / Time Factors / Urination Disorders - etiology