Morbidity after neoadjuvant radiochemotherapy is difficult to assess and depends on a lot of variables, i.e., abdominoperineal resection vs. sphincter-saving surgery, type of anastomoses, presence of a diverting stoma, the schedule of RT (dose, fractions), the kind of chemotherapy, the interval between the end of systemic pre-operative therapy and surgery, timing of follow-up, etc. It is reported in literature between 9 and 61%. Comparison of different studies is inconclusive .
Generally, with the latest protocols of radiochemotherapy, there does not seem to be a significant increase in morbidity; some Authors report a tendency towards higher rates of infections, anasto-motic failure or stricture, but without conclusive data. Pre-operative RT may inhibit healing and contribute to wound complications including delayed wound healing (>1 month), and wound infection requiring drainage or debridement or reoperation in about 40% of cases of patients that undergo APR. Surgeons especially fear anastomotic leakage and pelvic abscess, the leakage incidence rate ranged from 2 to 24% in the literature [60-62].
Pelvic drainage and the use of a defunctioning stoma were significantly associated with a lower anastomotic failure rate. Certainly a protective ileostomy does not influence the incidence rate of leakage of anastomosis but reduces the severity of complications .
There is no definitive answer to the influence of RT regarding functional results after conservative surgery. Adequate shielding of the anal sphincter is recommended. Poor functional results (faecal incontinence, more than four daily stools) are associated especially with low anastomosis, not with RT .
Neoadjuvant radiochemotherapy adversely affects the functional outcome after total mesorectal excision. There is manometric evidence of a significant decrease of mean resting pressure and mean resting vector volume, as compared with surgery only, as chemoradia-tion causes internal sphincter fibrosis .
Radiation can result in a negative effect on sexual functioning in females and males, with a higher frequency of ejaculation disorders and erectile functioning that worsen over time . Despite a decrease in sexual function and body image in patients that undergo an APR, one year after combined treatment patients exhibit improvement in some important quality of life outcomes .
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