Impact of intra-operative radiotherapy on evacuatory function following ultra-low anterior resection. A preliminary result of prospective randomized trial.

Background/aims: Preoperative radiotherapy and/or chemotherapy have been reported as effective treatment for locally advanced low rectal carcinoma. However, recent follow-up studies represented severe postoperative evacuatory disorder, which annoys patients' quality of life.

Methodology: The present study was a part of a randomized trial protocol comparing between intraoperative radiotherapy with pelvic autonomic nerve preservation and control group without radiation. Of these, 24 patients having sphincter preservation were followed in terms of their bowel function with questionnaire and anorectal manometry.

Results: In terms of background, patients' age, gender, depth of the tumor invasion and lymph node metastasis showed no significant difference between the groups. After stoma closure, frequency of bowel movement was increased and incontinence scores worsened in both groups. However, no significant difference was noted between the groups, postoperatively. Regarding anorectal manometry, postoperative anal sphincter tones were stable compared even to pre-operative findings and no difference was noted between the groups postoperatively. Anal canal length and sensory factor were stable and no difference between the groups. Volumetric factors such as rectal capacity and maximum tolerable volume were also stable even after ultra-low anterior resection.

Conclusions: Intraoperative radiotherapy did not affect adversely on evacuatory function following ultra-low anterior resection in the early postoperative period. Long-term follow-up is warranted.