Long-term functional results of radiation after coloanal anastomosis

ABSTRACT

Surgery is the only treatment that can cure most patients with colorectal cancer. Radiation therapy (pre or postoperative) has been shown to improve results by decreasing local recurrence and improving survival. Our aim was to analyze whether postoperative radiation influenced long-term functional outcomes and the probability of stricture of anastomosis in patients who underwent coloanal anastomosis for rectal cancer. Methods: The records of 84 patients with coloanal anastomosis for rectal cancer were studied between 1980 and 1996. There were 82 males and 28 females. Mean age was 57.8 years (range 24 to 78 years). Mean distal resection margin was 2.6 cm (range 0 to 14cm). Twenty-three patients received postoperative irradiation therapy. Patients who received chemotherapy were not included in the study. Results were analysed by examination , telephone or questionnaire. Mean follow-up was 3.8 years (range 0 to 13 years). Results: There was no operative mortality. Functional variables were much better in non-irradiated patients. The irradiated group had more number of stools/day (p>0.05), more number of stools/ night (p>0.05), more incontinence/day (p 0.05) and more incontinence/night (p 0.05). Irradiated patients also wore more pads (p 0.05) than non-irradiated patients. The probability of remaining free of stricture at 5 years was slightly better in non-irradiated (72 percent) than in irradiated patients (65 percent, p>0.05). Conclusion: Postoperative irradiation after colo-anal anastomosis for rectal cancer is safe, but may increase the risk of stricture of anastomosis and does affect functional results adversely.