Impaired continence function five years after intensified chemoradiation in patients with locally advanced rectal cancer

Aims: While the influence on survival is only seen in patients with complete regression after neoadjuvant treatment in locally advanced rectal cancer the impairment of the continence capacity weighs even more for patients with little oncological benefit. Methods: Patients treated with intensified preoperative radiochemotherapy patients treated only by TME surgery were asked five years after treatment to complete the Wexner and SF-12 quality of life questionnaire. Results: 25 after neoadjuvant treatment had a median Wexner score of 14 [3-20] after 63 [42-78] months. Histopathological stage or grade of regression did not influence the Wexner score (p = 0.76, resp. p = 0.9). 12% describe themselves as being permanently continent; 40% are stool incontinent "always" or "most of the time". 68% are always wearing pads. 29 patients after TME only showed a median Wexner score of 5 [range 0-17] after 66 months [26-133]. SF-12 showed significantly lower values in physical (p = 0.02) as well as mental summary scales (p = 0.015) in patients after RCTX while patients after radical surgery showed no difference to the norm population. Conclusion: This study shows that continence is significantly worse five years after neoadjuvant treatment. Moreover, patients after neoadjuvant treatment and surgery have impaired quality of life compared to norm population. These results may contribute to the discussion of only applying neoadjuvant chemoradiation selectively in patients with advanced rectal cancer. (C) 2013 Elsevier Ltd. All rights reserved.