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01-01-2006

Preoperative Chemoradiation for Rectal Cancer Causes Prolonged Pudendal Nerve Terminal Motor Latency

Authors: Jit F. Lim, M.B.B.S., F.R.C.S. (Glasg.), Joe J. Tjandra, M.D., F.R.A.C.S., Richard Hiscock, M.B.B.S., F.A.N.Z.C.A., Michael W. T. Chao, M.B.B.S., F.R.A.N.Z.C.R., Peter Gibbs, M.B.B.S., F.R.A.C.P.

Published in: Diseases of the Colon & Rectum | Issue 1/2006

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 chemoradiation.

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 chemoradiation.

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.

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Title: Preoperative Chemoradiation for Rectal Cancer Causes Prolonged Pudendal Nerve Terminal Motor Latency
Authors: Jit F. Lim, M.B.B.S., F.R.C.S. (Glasg.)
Joe J. Tjandra, M.D., F.R.A.C.S.
Richard Hiscock, M.B.B.S., F.A.N.Z.C.A.
Michael W. T. Chao, M.B.B.S., F.R.A.N.Z.C.R.
Peter Gibbs, M.B.B.S., F.R.A.C.P.
Publication date: 01-01-2006
Publisher: Springer-Verlag
Published in: Diseases of the Colon & Rectum / Issue 1/2006
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI: https://doi.org/10.1007/s10350-005-0221-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Preoperative Chemoradiation for Rectal Cancer Causes Prolonged Pudendal Nerve Terminal Motor Latency

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Purpose

Methods

Results

Conclusions

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