Abstracts
2000 Digestive Disease Week

# 2241 Long-Term Functional Results of Low Anterior Resection Following Preoperative Radiochemoterapy for Rectal Cancer.
Salvatore Pucciarelli, Riccardo Marchesin, Paola Toppan, Carlo Schievano, Mario Lise, Padova, Italy

Introduction: Our aim was to establish whether preoperative combined radiotherapy (RT)±chemotherapy affects long-term functional results following low anterior resection (LAR). Methods: Questionnaires were sent to 61/101 patients who underwent LAR for mid/low rectal cancer between 1994 and 1998 after applying the following exclusion criteria: recurrence, postoperative follow-up <1 yr, postoperative RT, and age >80 yrs. Fecal continence was investigated using the American Medical System questionnaire (score 1- 120), and quality of life (Qol) using the EuroQol EQ-5D (scale 0.60 - 1) and a visual analog scale (VAS) (0 - 100). Results: 54 patients (mean age 59 yrs, range 33-80; M:F, 42:12) responded. Eight colo-anal and 46 colorectal anastomosis were performed; colonic pouch and diverting stoma were constructed in 13 and 37 cases respectively; mean distance of the anastomosis from the anal verge was 5 cm; in 7 cases no tumor was found on the surgical specimen, TNM stages of the remaining 47 were: I (n=26), II (n=14), III (n=6), and IV (n=1). Major anastomotic leak and stricture were found in 7 and 6 patients respectively. Mean follow-up was 28 (range 12-65) mos. 22 patients referred full continence, 8 soiling, 21 episode(s) of incontinence to liquid stools, and 3 to solid stools; 34 patients underwent preoperative RT±chemotherapy, these patients were younger (p<.05) and had lower tumor (p<.05) and anastomosis sites (p<.05) than patients without preoperative adjuvant therapy. The mean Qol score was 0.88 and the mean VAS 78.4%. At ANOVA analysis, variables associated with a poor continence were: preoperative RT±chemotherapy (p<.033) and anastomotic leak (p<.037). No variables were associated to Qol and VAS. At step-wise linear regression procedure, anastomotic leak was the only independent variable with a negative effect on continence. With the same procedure no variable has been found affect Qol and VAS. Conclusion: Preoperative combined RT±chemotherapy does not affect continence and quality of life following LAR for rectal cancer.