Features of anorectal function after radiation therapy in patients with rectal cancer Текст научной статьи по специальности «Клиническая медицина»

South Russian Journal of Cancer. 2024. Vol. 5, No. 2. P. 25-34

4.0

https://doi.org/10.37748/2686-9039-2024-5-2-3

https://elibrary.ru/cmrrin

South Russian

Journal of Cancer

ORIGINAL ARTICLE

Южно-Российский

онкологический журнал

Vol. 5

Features of anorectal function after radiation therapy in patients No. 2, 2024

with rectal cancer

O. I. Kit, O. K. Bondarenko, Yu. A. Gevorkyan, N. V. Soldatkina, M. A. Gusareva, N. G. Kosheleva, A. A. Solntseva, D. S. Petrov, D. A. Savchenko

National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation bondarenkoo.olga@yandex.ru

ABSTRACT

Purpose of the study. To study the function of the sphincter in patients with rectal cancer after chemoradiotherapy using the method of high-resolution anorectal manometry.

Patients and methods. The study included 30 patients with cancer of the middle and lower ampullary rectum, who underwent combined treatment at the National Medical Research Center of Oncology. The patients underwent a course of neoadjuvant gamma radiation therapy using capecitabine. High-resolution anorectal manometry was performed before the start of treatment and 2 months after completion of chemoradiotherapy to study the functional parameters of the sphincter apparatus.

The severity of anorectal dysfunction was assessed using the Wexner anal incontinence scale.

Results. According to high-resolution anorectal manometry, the average pressure of the anal canal at rest decreased by 1.4 times ( p < 0.05), and the average absolute compression pressure with voluntary contraction decreased by 1.2 times ( p = 0.0012) after neoadjuvant chemoradiotherapy. A comparative assessment of the maximum absolute compression pressure at this stage of treatment did not allow us to trace a significant difference between its value before the start of radiation therapy and 2 months after its completion ( p > 0.05). An increase in threshold sensitivity volumes was noted in 23 patients ( p = 0.16).

The use of the Wexner scale didn’t show a statistically significant change in the median scores according to the results of patient surveys following the completion of treatment (5.2 vs. 5.5 points, p > 0.05).

Conclusions. Radiation therapy has an effect on anorectal function, which may contribute to the occurrence of low anterior resection syndrome after surgical treatment. For this reason, it is now necessary to carefully consider the risks of developing anorectal dysfunction. Equally important is the use of methods for the prevention of low anterior resection syndrome for patients who have received combined treatment for rectal cancer.

Keywords: low anterior resection syndrome, high-resolution anorectal manometry, neoadjuvant chemoradiotherapy For citation: Kit O. I., Bondarenko O. K., Gevorkyan Yu. A., Soldatkina N. V., Gusareva M. A., Kosheleva N. G., Solntseva A. A., Petrov D. S., Savchenko D. A. Features of anorectal function after radiation therapy in patients with rectal cancer. South Russian Journal of Cancer. 2024; 5(2): 25-34.

https://doi.org/10.37748/2686-9039-2024-5-2-3, https://elibrary.ru/cmrrin For correspondence: Olga K. Bondarenko – PhD student, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation Address: 63 14 line str., Rostov-on-Don 344037, Russian Federation E-mail: bondarenko.olga@yandex.ru

ORCID: https://orcid.org/0000-0002-9543-4551

SPIN: 7411-8638, AuthorID: 1223821

Compliance with ethical standards: the work followed the ethical principles set forth in the World Medical Association Declaration of Helsinki, 1964, ed. 2013. The study is approved by the Committee on Biomedical Ethics at the National Medical Research Center for Oncology (extract from the protocol of the meeting No. 28 dated 09/09/2022). Informed consent was received from all participants of the study Funding: this work was not funded

Conflict of interest: Kit O. I., Soldatkina N. V. has been the member of the editorial board of the South Russian Journal of Cancer since 2019, however he has no relation to the decision made upon publishing this article. The article has passed the review procedure accepted in the journal.

The authors did not declare any other conflicts of interest The article was submitted 03.11.2023; approved after reviewing 26.03.2024; accepted for publication 09.05.2024

© Kit O. I., Bondarenko O. K., Gevorkyan Yu. A., Soldatkina N. V., Gusareva M. A., Kosheleva N. G., Solntseva A. A., Petrov D. S., Savchenko D. A., 2024

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Южно-Российский онкологический журнал. 2024. Т. 5, № 2. С. 25-34

https://doi.org/10.37748/2686-9039-2024-5-2-3

https://elibrary.ru/cmrrin

3.1.6. Онкология, лучевая терапия

ОРИГИНАЛЬНАЯ СТАТЬЯ

Особенности аноректальной функции после лучевой терапии у больных раком

прямой кишки

О. И. Кит, О. К. Бондаренко, Ю. А. Геворкян, Н. В. Солдаткина, М. А. Гусарева, Н. Г. Кошелева, А. А. Солнцева, Д. С. Петров, Д. А. Савченко

ФГБУ «Национальный медицинский исследовательский центр онкологии» Министерства здравоохранения Российской Федерации, г. Ростов-на-Дону, Российская Федерация

bondarenkoo.olga@yandex.ru

РЕЗЮМЕ

Цель исследования. Изучение функции сфинктерного аппарата у больных раком прямой кишки после химиолучевой

терапии с помощью метода аноректальной манометрии высокого разрешения.

Пациенты и методы. В исследовании принимали участие 30 больных раком среднеампулярного и нижнеампуляр-ного отделов прямой кишки, проходивших комбинированное лечение в ФГБУ «Национальный медицинский исследовательский центр онкологии» Министерства здравоохранения Российской Федерации. Пациентам выполнялся

курс неоадьювантной дистационной гамма- терапии с применением капецитабина. Для изучения функциональных

параметров сфинктерного аппарата выполняли аноректальную манометрию высокого разрешения до начала лечения и через 2 мес. после завершения химиолучевой терапии. Степень выраженности аноректальной дисфункции

оценивали с использованием шкалы анальной инконтиненции Wexner.

Результаты. После проведения неоадьювантной химиолучевой терапии по данным аноректальной манометрии

высокого разрешения показатель среднего давления анального канала в состоянии покоя снижался в 1,4 раза

( р < 0,05), а среднее абсолютное давление сжатия при волевом сокращении уменьшалось в 1,2 раза ( р = 0,0012).

Сравнительная оценка максимального абсолютного давления сжатия на данном этапе лечения не позволила про-следить достоверного отличия между его значением до начала лучевой терапии и через 2 мес. после ее завершения

( р > 0,05). У 23 пациентов было отмечено увеличение пороговых объемов чувствительности ( р = 0,16). Применение

шкалы Wexner не показало статистически значимого изменения медианы баллов по результатам опросов пациентов

после завершения лечения (5,2 против 5,5 баллов, р > 0,05).

Заключение. Лучевая терапия оказывает влияние на аноректальную функцию, что может способствовать возник-новению синдрома низкой передней резекции после хирургического лечения. По этой причине в настоящее время

необходимо учитывать риски развития аноректальной дисфункции. Не менее важным является использование

методов профилактики синдрома низкой передней резекции для больных, получивших комбинированное лечение

по поводу рака прямой кишки.

Ключевые слова: синдром низкой передней резекции, аноректальная манометрия высокого разрешения, неоа-дьювантная химиолучевая терапия

Для цитирования: Кит О. И., Бондаренко О. К., Геворкян Ю. А., Солдаткина Н. В., Гусарева М. А., Кошелева Н. Г., Солнцева А. А., Петров Д. С., Савченко Д. А. Особенности аноректальной функции после лучевой терапии у больных раком прямой кишки. Южно-Российский онкологический журнал. 2024; 5(2):25-34. https://doi.org/10.37748/2686-9039-2024-5-2-3, https://elibrary.ru/cmrrin Для корреспонденции: Бондаренко Ольга Константиновна – аспирант, ФГБУ «Национальный медицинский исследовательский центр

онкологии» Министерства здравоохранения Российской Федерации, г. Ростов-на- Дону, Российская Федерация

Адрес: 344037, Российская Федерация, г. Ростов-на- Дону, ул. 14-я линия, д. 63

E-mail: bondarenko.olga@yandex.ru

ORCID: https://orcid.org/0000-0002-9543-4551

SPIN: 7411-8638, AuthorID: 1223821

Соблюдение этических стандартов: в работе соблюдались этические принципы, предъявляемые Хельсинкской декларацией Всемирной

медицинской ассоциации (World Medical Association Declaration of Helsinki, 1964, ред. 2013). Исследование одобрено Комитетом по

биомедицинской этике при ФГБУ «Национальный медицинский исследовательский центр онкологии» Министерства здравоохранения

Российской Федерации (выписка из протокола заседания № 28 от 09.09.2022 г.). Информированное согласие получено от всех

участников исследования

Финансирование: финансирование данной работы не проводилось

Конфликт интересов: Кит О. И., Солдаткина Н. В. являются членами редакционной коллегии журнала «Южно- Российский онкологический

журнал» с 2019 г., но не имеют никакого отношения к решению опубликовать эту статью. Статья прошла принятую в журнале процедуру

рецензирования. Об иных конфликтах интересов авторы не заявляли

Статья поступила в редакцию 03.11.2023; одобрена после рецензирования 26.03.2024; принята к публикации 09.05.2024

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Южно-Российский онкологический журнал 2024. Т. 5, № 2. С. 25-34

Кит О. И., Бондаренко О. К., Геворкян Ю. А., Солдаткина Н. В., Гусарева М. А., Кошелева Н. Г., Солнцева А. А., Петров Д. С., Савченко Д. А. Особенности

аноректальной функции после лучевой терапии у больных раком прямой кишки

INTRODUCTION

discharge and defecation with the possible develop-

ment of incontinence [13]. Similar clinical manifes-

In 2020, 1,931,590 new cases of colorectal cancer

tations may occur with varying frequency in patients

and 935,173 deaths were detected worldwide, while

with rectal cancer after low anterior resection [14].

in Russia these morbidity and mortality rates were

Therefore, it is relevant to study anorectal function

77,213 and 42,079 cases, respectively [1]. Statisti-

at different stages of treatment in order to develop

cal data indicate that the problem of diagnosis and

individual methods for preventing the development

treatment of rectal cancer continues to be relevant.

and correction of these symptoms.

The standard of treatment for patients with locally

The anorectal dysfunction symptom assessment

advanced cancer of the middle and lower ampullary

system includes various questionnaires, the most

parts of the rectum is neoadjuvant chemoradiothera-

widely used of which are the low anterior resection

py followed by surgical treatment with total mesorec-

syndrome and Wexner scales. In the analysis of the

tumectomy. An important aspect in the treatment

randomized clinical trial of FOWARC, neoadjuvant

of rectal cancer remains an organ- preserving strat-

radiation therapy was associated with a worse low

egy using nerve- sparing techniques [2]. Maintaining

anterior resection syndrome score and quality of

the integrity and functional activity of the sphincter

life [15]. However, the question of the effect of neo-

avoids the need for the formation of a lifelong co-

adjuvant therapy on functional outcomes in patients

lostomy and improves the quality of the patients’

after combined treatment of rectal cancer currently

lives [3].

remains controversial.

The use of radiation therapy at the first stage of

An objective assessment of the function of the

combined treatment can reduce the risk of local re-

sphincter apparatus of the rectum can be obtained

currence by reducing the size of the tumor process

by performing high-resolution anorectal manometry.

and improve the long-term survival of patients [4,

This method of investigation represents the pressure

5]. Modern modified radiation therapy not only re-

distribution in the anal canal, both at rest and when

duces the size of the primary tumor, but also reduc-

performing physiological tests. The advantage of

es the area of radiation for surrounding tissues [6].

high-resolution anorectal manometry is the use of

Nevertheless, neoadjuvant chemoradiotherapy

a higher physiological resolution created by the in-

may negatively affect the work of the sphincter of

creased density of sensitive sensors and their loca-

the rectum [7]. Due to the increase in the number

tion around the circumference [16]. High-resolution

of sphincter- preserving surgical interventions and

anorectal manometry displays changes in anorectal

non-adjuvant radiation therapy in recent years, more

activity at rest and with various functional tests in

and more attention has been paid to functional re-

the form of a colored contour graph [17].

sults [8, 9]. Systematic reviews consider radiation

The purpose of the study: to study the indicators

therapy as one of the significant risk factors for in-

of the functional state of the sphincter apparatus

testinal dysfunction [10].

in patients with rectal cancer after chemoradiother-

According to a number of authors, the effect of

apy using the method of high-resolution anorectal

radiation therapy is associated with the development

manometry.

of fibrous changes in structures and tissues exposed

to radiation [6, 11]. By reducing the elasticity of the

PATIENTS AND METHODS

rectum by thickening its wall, radiation therapy leads

to a deterioration in long-term functional results [12].

The analysis of changes in the anorectal func-

When the primary tumor is located close to the anal

tion of the sphincter was performed in patients un-

canal, the sphincter apparatus is often also in the

dergoing observation and treatment in the period

field of high radiation doses, which can affect the

from 2022 to 2023 at the National Medical Research

tone of the sphincters, reducing the contractility of

Center for Oncology, Ministry of Health of the Rus-

the locking apparatus [10].

sian Federation. The study included 30 patients

Changes in the functioning of the sphincter ap-

with a confirmed diagnosis of cancer of the middle

paratus may include an increase in the frequency

and lower ampullary rectum. At the time of treat-

of urges and a deterioration in the control of gas

ment, the average age of patients was 63.2 years

27

South Russian Journal of Cancer 2024. Vol. 5, No. 2. P. 25-34

Kit O. I., Bondarenko O. K., Gevorkyan Yu. A., Soldatkina N. V., Gusareva M. A., Kosheleva N. G., Solntseva A. A., Petrov D. S., Savchenko D. A. Features of anorectal function after radiation therapy in patients with rectal cancer (patients ranged in age from 40 to 76 years). At the

STUDY RESULTS

same time, 60 % of men (18 patients) and 40 % of

women (12 patients) were men. According to the

Since the onset of rectal cancer in patients, the

results of histological analysis, adenocarcinoma with

clinical manifestations of tumor lesions have ranged

a predominance of a moderately differentiated tumor

from episodes of intestinal discomfort and irregular

form was observed in patients (56.7 %). In 16 pa-

stools to involuntary defecation. Of the total study

tients (53.3 %), the primary tumor site was located at

group, 16 cases (53.3 %) had loose stools more of-

a distance of < 5 cm from the anorectal junction. The

ten than 5 times a day, 12 patients (40 %) had false

median distance from the lower edge of the tumor

urges to defecate, 7 patients (23.3 %) had manifes-

to the anodermal junction was 6.5 cm (3–10 cm).

tations of anal incontinence in the form of cases of

Patients underwent conformal remote radiother-

uncontrolled gas discharge and 4 of them (13.3 %)

apy with a single focal dose of 2 Gy 5 times a week

had incontinence intestinal contents.

to a total focal dose of 50–54 Gy per primary tumor

Functional changes in the internal anal sphinc-

focus and 44 Gy on the path of regional metastasis.

ter reflect the parameters of resting anal pressure.

Radiation therapy was accompanied by modification

When comparing the obtained indicators, the level

with capecitabine at a dosage of 1,650 mg/m2 per

of average anal pressure at rest in patients has de-

day orally in two doses on the days of the sessions.

creased by 1.4 times after completion of the course

To study the functional parameters of the rectal

of chemoradiotherapy ( p < 0.05) (Fig. 1).

sphincter, high-resolution anorectal manometry was

A similar trend was observed when estimating the

performed using water perfusion technology with

average absolute compression pressure with volun-

an 8-channel catheter of the WMP Solar GI device

tary contraction. 2 months after the completion of

(MMS, Holland). The study was conducted before

radiation therapy, its index in patients decreased by

the start of treatment and 2 months after the end

1.2 times ( p = 0.0012). A comparative assessment

of chemoradiotherapy. Anorectal manometry was

of the maximum absolute compression pressure

performed according to a standard procedure in the

at this stage of treatment did not allow us to trace

position of a patient with bent knee and hip joints.

a significant difference between its value before the

The level of average anal pressure in the anal ca-

onset of radiation therapy and 2 months after its

nal at rest and the levels of average and maximum

completion ( p > 0.05). The values of the obtained compression pressure were assessed. To study the

parameters of high-resolution anorectal manometry

sensitivity and reservoir function of the rectum, the

are presented in Table 1.

first rectal sensation, the volume at the first urge to

Attention was drawn to a decrease in the endur-

defecate and the maximum tolerable volume when

ance of volitional contraction and an increase in

filling the balloon with air were recorded.

muscle fatigue during functional tests. Upon com-

The severity of dysfunction of the sphincter ap-

pletion of chemoradiotherapy, there was a decrease

paratus of the rectum was assessed according to

in the median duration of sphincter contraction from

clinical gradation using the Wexner anal incontinence

an average of 22 seconds from the initial state to

scale. The results of the scale are presented in the

18 seconds. Also, an increase in threshold sensitivity

form of points from 0 to 20, while intestinal incon-

volumes was noted in 23 patients, but no statistical

tinence is established when 12 points or more are

difference was found when comparing these indica-

scored.

tors ( p = 0.16).

According to the Shapiro- Wilk criterion, the pa-

The study of anorectal function on the Wexner

rameters considered in the study had a distribution

scale did not show a statistically significant change

different from normal. Statistical data processing

in the median scores according to the results of pa-

was carried out using the Statistica 13.0 package.

tient surveys after completion of the neoadjuvant

Quantitative data in our study were represented by the

stage of treatment (5.2 points and 5.5 points before

median (Me) and quartile values Q1 and Q3 in the Me

treatment and after radiation therapy, respectively,

(Q1 – Q3) format. The nonparametric Mann- Whitney

p > 0.05). Before the start of treatment, a minimum criterion was used to compare the variables of two

score of 2 points on the Wexner scale was observed in

samples (before and after chemoradiotherapy).

11 patients (36.7 %), while in 7 of them (23.3 %) after

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Южно-Российский онкологический журнал 2024. Т. 5, № 2. С. 25-34

Кит О. И., Бондаренко О. К., Геворкян Ю. А., Солдаткина Н. В., Гусарева М. А., Кошелева Н. Г., Солнцева А. А., Петров Д. С., Савченко Д. А. Особенности

аноректальной функции после лучевой терапии у больных раком прямой кишки

radiation therapy, the minimum threshold increased

on the direct effect of neoadjuvant radiation thera-

to 4 points. At the same time, the number of patients

py on the sphincter apparatus [9, 10]. In this study,

with a maximum score of 13 points on the Wexner

the effect of radiation therapy on the function of the

scale did not change after radiation therapy (13.3 %).

sphincter apparatus of the rectum was evaluated in

accordance with manometric parameters and clinical

DISCUSSION

manifestations.

Anorectal function is a complex physiological

Chemoradiotherapy at the first stage of treatment

mechanism, an important role in the implementa-

in patients with cancer of the middle and lower amp-

tion of which belongs to the sphincter apparatus of

ullary rectum increases the possibility of performing

the rectum. The activity of the smooth muscles of

organ- preserving treatment and improves oncolog-

ical treatment results by reducing the frequency of

local tumor recurrence by less than 6 % [13]. How-

120

ever, along with this advantage, the use of radiation

110

therapy followed by anterior rectal resection and

100

total mesorectomectomy is associated with higher

e

rates of intestinal dysfunction [18]. The development

90

of anorectal dysfunction of varying severity after

essur 80

combined treatment of rectal cancer was associated

70

with a deterioration in the quality of life in 19–52 %

Resting pr

of patients [19].

60

There are many works in the modern literature

50

describing a more significant effect of combined

40

treatment on the sphincter apparatus of the rectum

compared with surgical intervention [13, 20]. Surgical

30

trauma can cause neurogenic damage to the locking

20

apparatus due to mobilization, especially with low

Before radiation therapy

After radiation therapy

rectal resections [21]. Intraoperative trauma in the

Grouping

form of anal dilation can affect both the external

Median 25 –75 % Min. Max.

and internal anal sphincters with a transient zone

and the so-called "hemorrhoidal cushion" [22]. How-Fig. 1. Comparative assessment of the resting pressure index in ever, there are much fewer studies providing data

the anal canal

Table 1. Parameters of anorectal manometry of the subjects studied during radiation therapy Parameter

Before the start of

After radiation

treatment Me (Q1; Q3)

therapy Me (Q1; Q3)

р

Average anal pressure at rest (mmHg)

87 (73; 92)

61 (55; 74)

р < 0.05

Average absolute compression pressure (mmHg)

154 (128; 173)

124 (102; 139)

р = 0.0012

Maximum anal compression pressure (mmHg)

196 (161; 221)

176 (149; 139)

р > 0.05

Endurance Test time (sec)

22 (17; 25)

18 (11; 23)

р > 0.05

Threshold sensitivity volume (ml)

35 (28; 49)

46 (41; 54)

р = 0.16

Threshold sensitivity volume (ml)

35 (28; 49)

46 (41; 54)

р = 0.16

29

South Russian Journal of Cancer 2024. Vol. 5, No. 2. P. 25-34

Kit O. I., Bondarenko O. K., Gevorkyan Yu. A., Soldatkina N. V., Gusareva M. A., Kosheleva N. G., Solntseva A. A., Petrov D. S., Savchenko D. A. Features of anorectal function after radiation therapy in patients with rectal cancer the internal anal sphincter maintains pressure in the

the relationship between radiation therapy and the

anal canal at rest. While the striated musculature

development of colorectal cancer failure (Kit O. I.

of the external anal sphincter and pelvic floor is in-

et al., 2018) [34].

volved in the implementation of arbitrary contraction,

On the other hand, the pathogenetic factor of the

especially over a long period [23]. The coordinated

negative effect of radiation therapy on the function

functioning of the anal sphincters and the ampoule

of anal sphincters is vascular fibrosis, pelvic and

of the rectum provides the possibility of adequate

musculoskeletal plexus [11, 32, 35]. Some research-

implementation of the locking function [24].

ers describe a malfunction of the function of the

The results of the analysis demonstrate a de-

internal anal sphincter, which is not even included in

crease in resting pressure after a neoadjuvant

the radiation field, which can also affect the capacity

course of radiation therapy, which is confirmed by

and pliability of the rectum [36]. The above facts con-

information from other studies found in modern lit-

tribute to the development of anorectal dysfunction

erature [25, 26]. At the same time, the above data

and the occurrence of anal incontinence in some of

did not reveal a significant change in the work of

the treated patients.

the external anal sphincter compared with the work

Irradiation of the rectum causes weakening of the

of the internal sphincter. Also, several publications

anal sphincter, as well as impaired processing of

showed no changes in the work of the external anal

anorectal sensory stimuli [36]. According to a study

sphincter after radiation therapy [26–28]. However,

conducted by van der Sande M. E. et al. (2019), the

in our study, a decrease in the average values of

relationship between the dose of radiation therapy

anal compression pressure was observed, which

and the severity of anorectal dysfunction in patients

can be considered as a possible prerequisite for

with rectal cancer was monitored [37].

a decrease in the strength and endurance of arbi-

Clinical manifestations of the negative effects of

trary contraction.

radiation therapy on the function of the rectal occlu-

Randomized studies demonstrate a decrease in

sion apparatus may be characterized by a specific

resting pressure in the postoperative period after

pattern. Most authors report a higher frequency of

neoadjuvant radiation therapy due to deterioration of

loose stools and urge to defecate after radiation

the internal sphincter [29, 30]. Irradiation is associat-

therapy, signs of anal incontinence in the form of

ed with damage to the sacral plexus and with fibrous

incontinence of gases and intestinal contents and

changes in the muscle fibers of the sphincters [31].

laundry contamination are less common [13, 26, 28].

The greater susceptibility to radiation exposure of

However, according to the data obtained in our study,

the internal sphincter compared with the external one

there was no significant difference in the clinical

may be due to such features as a smaller number of

picture before and after radiation therapy. The most

muscle fibers and innervation by a thin network of

frequent complaints, as well as before the start of

nerve fibers of the pelvic plexus [28].

treatment, were frequent loose stools and false urge

Changes in the locking apparatus of the rectum

to defecate. Only a small number of patients had cas-

were also noted during morphological examination.

es of uncontrolled gas discharge and incontinence

Histological analysis revealed damage to the my-

of intestinal contents.

enteric plexus of the internal anal sphincter, and

De Nardi and co-authors studied 39 patients with

there was also a tendency to increased collagen

rectal cancer before and after radiation therapy. The

deposition in this structure [32].

results of anorectal manometry showed a significant

The pathogenetic aspects of the effect of radi-

decrease only in resting pressure after the treatment.

ation therapy on the blocking function are studied

When assessing incontinence on the Wexner scale

in many studies. In the work of Rahbari N. N. et al.,

before neoadjuvant therapy, 5 patients already had

(2013) it was found that radiation therapy can not

mild incontinence with an average score of 3, and

only cause difficulties in performing total mesorecto-

after neoadjuvant therapy, 11 reported incontinences

mies, but also reduce the ability of irradiated tissues

with an average score of 3.8 [38].

to repair, thereby leading to an increase in a number

When assessing the quality of the function of the

of complications in patients after low anterior rec-

sphincter apparatus according to the Wexner scale,

tal resection [33]. The literature has also described

no significant difference in the median scores was

30

Южно-Российский онкологический журнал 2024. Т. 5, № 2. С. 25-34

Кит О. И., Бондаренко О. К., Геворкян Ю. А., Солдаткина Н. В., Гусарева М. А., Кошелева Н. Г., Солнцева А. А., Петров Д. С., Савченко Д. А. Особенности

аноректальной функции после лучевой терапии у больных раком прямой кишки

noted in our work according to the results of the

CONCLUSION

patient survey. This fact suggests that radiation ther-

apy does not always cause deterioration of clinical

Radiation therapy may affect the function of the

symptoms on the part of the evacuation function.

rectal occlusion apparatus, especially the internal

Thus, in our study, changes in the manometric

anal sphincter. These changes may contribute to the

parameters of the internal and external anal sphinc-

formation of low anterior rectal resection syndrome

ters, a decrease in the endurance of contractions of

after surgery. For this reason, it is now necessary to

the rectal locking apparatus were not accompanied

consider the risks of developing anorectal dysfunc-

by significant clinical manifestations. However, the

tion. Equally important is the use of methods for

changes we have identified may become a prerequi-

the prevention of low anterior resection syndrome

site for the development of anal incontinence after

for patients who have received combined treatment

completion of treatment.

for rectal cancer.

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Information about authors:

Oleg I. Kit – Academician at the Russian Academy of Sciences, Dr. Sci. (Med.), professor, general director, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation

ORCID: https://orcid.org/0000-0003-3061-6108, SPIN: 1728-0329, AuthorID: 343182, ResearcherID: U-2241-2017, Scopus Author ID: 55994103100

Olga K. Bondarenko – PhD student, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation ORCID: https://orcid.org/0000-0002-9543-4551, SPIN: 7411-8638, AuthorID: 1223821

Yuriy A. Gevorkyan – Dr. Sci. (Med.), professor, head of the Department of Abdominal Oncology No. 2, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation

ORCID: https://orcid.org/0000-0003-1957-7363, SPIN: 8643-2348, AuthorID: 711165

Natalya V. Soldatkina – Dr. Sci. (Med.), leading researcher of the Department of General Oncology, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation

ORCID: https://orcid.org/0000-0002-0118-4935, SPIN: 8392-6679, AuthorID: 440046

Marina A. Gusareva – Cand. Sci. (Med.), head of the Radiological Department, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation

ORCID: https://orcid.org/0000-0002-9426-9662, SPIN: 9040-5476, AuthorID: 705242

Natalia G. Kosheleva – MD, radiotherapist of the Radiotherapy Department, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation

ORCID: https://orcid.org/0000-0001-7630-1502

Anna A. Solntseva – Cand. Sci. (Med.), MD, radiotherapist at the radiotherapy department, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation

ORCID: https://orcid.org/0000-0003-4052-3597

Dmitry S. Petrov – Cand. Sci. (Med.), Deputy CEO of Surgery, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation ORCID: https://orcid.org/0000-0002-4562-1199, SPIN: 1855-3496, AuthorID: 736631

Dmitry A. Savchenko – MD, oncologist of the consultative and diagnostic department, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation

ORCID: https://orcid.org/0000-0002-2496-2728

33

South Russian Journal of Cancer 2024. Vol. 5, No. 2. P. 25-34

Kit O. I., Bondarenko O. K., Gevorkyan Yu. A., Soldatkina N. V., Gusareva M. A., Kosheleva N. G., Solntseva A. A., Petrov D. S., Savchenko D. A. Features of anorectal function after radiation therapy in patients with rectal cancer Contribution of the authors:

Kit O. I., Gevorkyan Yu. A. – scientific editing, concept and design of the study; Bondarenko O. K. – scientific editing, preparation, concept and design of the study; Soldatkina N. V. – data collection, analysis and interpretation, material processing; Gusareva M. A. – text design;

Kosheleva N. G., Solntseva A. A. – data collection, analysis and interpretation; Petrov D. S., Savchenko D. A. – processing of the material.

34