Pre-operative radiotherapy in rectal cancer has a definite role: it results in tumour downstaging and allows an increasing number of cases of sphincter-preserving surgery in low tumours . However, it may result in impaired post-operative continence and increased frequency of defecation. This has been attributed to radiation injury to the sphincter and distal rectum. Exclusion of the anal sphincters from the field of radiation and reconstruction using colonic pouch-anal anastomosis has been shown to minimise post-operative dysfunction .
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