Abstracts
1999 Digestive Disease Week

# 2079 EARLY EFFECT OF PREOPERATIVE NEOADJUVANT RADIO-CHEMOTHERAPY ON THE ANAL SPHINCTER IN PATIENTS WITH ADVANCED RECTAL CARCINOMA
Werner Kauer, H Nekarda, H J Stein, J R Siewert, Tech Univ, Munchen Germany

The early effect of preoperative neoadjuvant radio-chemotherapy (RCTX) on the anal sphincter function in patients with advanced rectal carcinoma has not previously been investigated. We prospectively evaluated the acute effect of preoperative neoadjuvant RCTX on the anal sphincter function in this study. Ten patients (m : f = 7 : 3, median age 66 years, range 33 - 72 years) with locally advanced rectal carcinoma (cT3 cN0-2 cM0) were included in the study. After diagnosis and initial staging, including anal manometry and an incontinence questionnaire, all patients received neoadjuvant RCTX with 5-FU (250 mg/m2) and 45.0 Gy. Four to six weeks after RCTX preoperative restaging was performed. Anal manometry was done with a water perfused 8 channel system measuring sphincter length, resting pressure, squeeze pressure and sphincter vector volume (SVV). All patients had a normal incontinence score and sphincter length, resting pressure, squeeze pressure and SVV were within normal range before RCTX. While there was a slight decrease in median resting pressure, median squeeze pressure and median SVV after RCTX no significant changes could be found. One of the ten patients showed a pathologic incontinence score after RCTX and also had an abnormally low sphincter resting pressure, squeeze pressure and SVV after RCTX but was found to have tumor recurrence 6 months postoperatively. Preoperative neoadjuvant radio-chemotherapy has no or minimal acute effect on the anal sphincter function and does not contribute to postoperative incontinence.

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