THE LONG-TERM EFFECT OF ADJUVANT POSTOPERATIVE CHEMORADIOTHERAPY FOR RECTAL-CARCINOMA ON BOWEL FUNCTION

Objective The authors assessed the long-term effect of postoperative c hemoradiotherapy on bowel function. Summary Background Data Adjuvant p ostoperative radiation therapy, often combined with chemotherapy, is b eing used increasingly often for rectal carcinoma. However, the long-t erm effect of this treatment on bowel function has not been investigat ed. Methods The records were reviewed of all patients undergoing anter ior resection for rectal carcinoma 2 to 5 years previously. During thi s period, patients with Astler-Coller stage B2 or C tumors generally w ere given postoperative radiation therapy with chemotherapy, whereas t hose with earlier stage tumors were not. To minimize possible confound ing factors that may have been more common in the group receiving chem oradiotherapy and that may affect bowel function, extensive exclusion criteria were used, such as invasion of contiguous organs, local or di stant metastases, use of a dysfunctioning stoma, and anastomotic or pe lvic complications. One hundred remaining patients were suitable for i nclusion in the study and participated in a telephone questionnaire; 4 1 patients had postoperative chemoradiotherapy, and 59 did not. Result s The two groups were well matched for sex, level of anastomosis, and length of follow-up, although the group receiving chemoradiotherapy wa s slightly younger. The group that had chemoradiotherapy had more bowe l movements per day than the group that did not have radiation therapy (median 7 vs. median 2, p < 0.001); the former group had ''clustering '' of bowel movements more often (42% vs. 3%, p < 0.001), had nighttim e movements more often (46% vs. 14%, p < 0.001), had occasional or fre quent incontinence more often (39% and 17% vs. 7% and 0%, p < 0.001), wore a pad more often (41% vs. 10%, p < 0.001), and were unable to def er defecation for more than 15 minutes more often (78% vs. 19%, p < 0. 001). The group that had chemoradiotherapy also had stool of liquid co nsistency, used antidiarrheal medications, had perianal skin irritatio n, were unable to differentiate stool from gas, and needed to defecate again within 30 minutes of a movement significantly more often than t he group that did not receive chemoradiotherapy.