Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2022; 10(12): 3754-3763
Published online Apr 26, 2022. doi: 10.12998/wjcc.v10.i12.3754
Anorectal dysfunction in patients with mid-low rectal cancer after surgery: A pilot study with three-dimensional high-resolution manometry
Yan-Na Pi, Yi Xiao, Zhi-Feng Wang, Guo-Le Lin, Hui-Zhong Qiu, Xiu-Cai Fang
Yan-Na Pi, Zhi-Feng Wang, Xiu-Cai Fang, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Yi Xiao, Guo-Le Lin, Hui-Zhong Qiu, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Author contributions: Fang XC and Xiao Y were the guarantors and designed the study, enrolled and followed the patients, and critically revised the manuscript; Pi YN collected and analyzed the data and wrote the manuscript; Wang ZF participated in manometry and data interpretation; Lin GL and Qiu HZ enrolled and followed the patients; all authors reviewed the final version of this manuscript and agreed to its submission.
Supported by the National High-tech R & D Program (“863” Program) of China, No. 2010AA023007.
Institutional review board statement: The study was reviewed and approved by the Science and Research Office of Peking Union Medical College Hospital (Beijing).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: Data can be acquired from the corresponding author at fangxiucai2@aliyun.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiu-Cai Fang, MD, Chief Physician, Full Professor, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. fangxiucai2@aliyun.com
Received: November 4, 2021
Peer-review started: November 4, 2021
First decision: December 27, 2021
Revised: January 8, 2022
Accepted: March 6, 2022
Article in press: March 6, 2022
Published online: April 26, 2022
Processing time: 168 Days and 5.6 Hours
Abstract
BACKGROUND

The quality of life in patients who develop low anterior resection syndrome (LARS) after surgery for mid-low rectal cancer is seriously impaired. The underlying pathophysiological mechanism of LARS has not been fully investigated.

AIM

To assess anorectal function of mid-low rectal cancer patients developing LARS perioperatively.

METHODS

Patients diagnosed with mid-low rectal cancer were included. The LARS score was used to evaluate defecation symptoms 3 and 6 mo after anterior resection or a stoma reversal procedure. Anorectal functions were assessed by three-dimensional high resolution anorectal manometry preoperatively and 3-6 mo after surgery.

RESULTS

The study population consisted of 24 patients. The total LARS score was decreased at 6 mo compared with 3 mo after surgery (P < 0.05), but 58.3% (14/24) lasted as major LARS at 6 mo after surgery. The length of the high-pressure zone of the anal sphincter was significantly shorter, the mean resting pressure and maximal squeeze pressure of the anus were significantly lower than those before surgery in all patients (P < 0.05), especially in the neoadjuvant therapy group after surgery (n = 18). The focal pressure defects of the anal canal were detected in 70.8% of patients, and those patients had higher LARS scores at 3 mo postoperatively than those without focal pressure defects (P < 0.05). Spastic peristaltic contractions from the new rectum to anus were detected in 45.8% of patients, which were associated with a higher LARS score at 3 mo postoperatively (P < 0.05).

CONCLUSION

The LARS score decreases over time after surgery in the majority of patients with mid-low rectal cancer. Anorectal dysfunctions, especially focal pressure defects of the anal canal and spastic peristaltic contractions from the new rectum to anus postoperatively, might be the major pathophysiological mechanisms of LARS.

Keywords: Low anterior resection syndrome; Anorectal function; Three-dimensional high-resolution manometry; Rectal cancer

Core Tip: Rectal cancer is one of the most common malignant tumors in the world. Most patients with mid-low rectal cancer treated by anterior resections suffer anterior resection syndrome (ARS), which seriously impairs the quality of life and mental status. Therefore, the factors impacting anorectal function and its underlying mechanism need to be adequately investigated. Three-dimensional high-resolution anorectal manometry (3D HR-ARM), a more detailed instrument than traditional one, has rarely been used in these patients. In this study, we compared the perioperative anorectal functions of mid-low rectal cancer patients by 3D HR-ARM. Based on these data, focal pressure defects of the anal canal and spastic peristaltic contractions from the new rectum to anus postoperatively might be the major pathophysiological mechanisms of low ARS.