Pi YN, Xiao Y, Wang ZF, Lin GL, Qiu HZ, Fang XC. Anorectal dysfunction in patients with mid-low rectal cancer after surgery: A pilot study with three-dimensional high-resolution manometry. World J Clin Cases 2022; 10(12): 3754-3763 [PMID: 35647175 DOI: 10.12998/wjcc.v10.i12.3754]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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 bythe 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
ARTICLE HIGHLIGHTS
Research background
Low anterior resection syndrome (LARS) seriously impairs the quality of life and mental status of rectal cancer patients after radical surgeries, but the underlying mechanism is not clearly understood.
Research motivation
More and more rectal cancer patients have benefited from integrative treatment of surgery and chemo-radiotherapy and their survival rates have been improved. Improving the quality of life and alleviating the defecation related symptom are becoming much more important.
Research objectives
The aim of this research was to fully assess anorectal function of rectal cancer patients perioperatively.
Research methods
Mid-low rectal cancer patients were assessed with LARS score after surgery and three-dimensional high resolution anorectal manometry before and after surgery.
Research results
Twenty-four patients were included in this study. Their LARS scores decreased after surgery over time. The anorectal function detected by three-dimensional high resolution anorectal manometry after surgery was worse than that before surgery in all patients, especially in the neoadjuvant therapy group. The focal pressure defects of the anal canal and spastic peristaltic contractions from the new rectum to anus were detected in 70.8% and 45.8% of the patients, which were associated with higher LARS scores and rarely been reported before.
Research conclusions
Anorectal function worsens after surgery in mid-low rectal cancer patients. The focal pressure defects of anal canal and spastic peristaltic contractions from the new rectum to anus postoperatively might be involved in the pathophysiological mechanisms of LARS.
Research perspectives
More studies need to be done to confirm our finding that the anal focal pressure defects and spastic peristaltic contractions from the new rectum to anus might be involved in the pathophysiological mechanisms of LARS, and effective interventions should be explored to alleviate the suffering of rectal cancer patients after surgery.
