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

Loos, M; Quentmeier, P; Schuster, T; Nitsche, U; Gertler, R; Keerl, A; Kocher, T; Friess, H; Rosenberg, R

doi:10.1245/s10434-012-2827-z

journal article

Title:: Effect of Preoperative Radio(chemo)therapy on Long-term Functional Outcome in Rectal Cancer Patients: A Systematic Review and Meta-analysis.
Document type:: Journal Article
Author(s):: Loos, M; Quentmeier, P; Schuster, T; Nitsche, U; Gertler, R; Keerl, A; Kocher, T; Friess, H; Rosenberg, R
Abstract:: 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.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.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).Although quality of studies on long-term functional outcome is limited, current evidence demonstrates that pR(C)T negatively affects anorectal function after TME.
Journal title abbreviation:: Ann Surg Oncol
Year:: 2013
Journal volume:: 20
Journal issue:: 6
Pages contribution:: 1816-28
Language:: eng
Fulltext / DOI:: doi:10.1245/s10434-012-2827-z
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/23269466
Print-ISSN:: 1068-9265
TUM Institution:: Chirurgische Klinik und Poliklinik; Institut für Medizinische Statistik und Epidemiologie
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