cancerspЮжно-Российский онкологический журнал/ South Russian Journal of CancerSouth Russian Journal of Cancer2686-9039АНО "Перспективы онкологии"10.37748/2686-9039-2024-5-2-3cmrrincancersp-264Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОсобенности аноректальной функции после лучевой терапии у больных раком прямой кишкиFeatures of anorectal function after radiation therapy in patients with rectal cancerhttps://orcid.org/0000-0003-3061-6108КитО. И.KitO. I.

Кит Олег Иванович – академик РАН, д.м.н., профессор, генеральный директор, ФГБУ «Национальный медицинский исследовательский центр онкологии» Министерства здравоохранения Российской Федерации, г. Ростов-на-Дону, Российская Федерация

ORCID: https://orcid.org/0000-0003-3061-6108, SPIN: 1728-0329, AuthorID: 343182, ResearcherID: U-2241-2017, Scopus Author ID: 55994103100

Oleg I. Kit – Academician at the Russian Academy of Sciences, Dr. Sci. (Med.), professor, general director, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation

ORCID: https://orcid.org/0000-0003-3061-6108, SPIN: 1728-0329, AuthorID: 343182, ResearcherID: U-2241-2017, Scopus Author ID: 55994103100

super.gormon@yandex.ruhttps://orcid.org/0000-0002-9543-4551БондаренкоО. К.BondarenkoO. G.

Бондаренко Ольга Константиновна – аспирант, ФГБУ «Национальный медицинский исследовательский центр онкологии» Министерства здравоохранения Российской Федерации, г. Ростов-на-Дону, Российская Федерация

ORCID: https://orcid.org/0000-0002-9543-4551, SPIN: 7411-8638, AuthorID: 1223821

Olga K. Bondarenko – PhD student, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation

ORCID: https://orcid.org/0000-0002-9543-4551, SPIN: 7411-8638, AuthorID: 1223821

bondarenkoo.olga@yandex.ruhttps://orcid.org/0000-0003-1957-7363ГеворкянЮ. А.GevorkyanYu. A.

Геворкян Юрий Артушевич – д.м.н., профессор, заведующий отделением абдоминальной онкологии № 2, ФГБУ «Национальный медицинский исследовательский центр онкологии» Министерства здравоохранения Российской Федерации, г. Ростов-на-Дону, Российская Федерация

ORCID: https://orcid.org/0000-0003-1957-7363, SPIN: 8643-2348, AuthorID: 711165

Yuriy A. Gevorkyan – Dr. Sci. (Med.), professor, head of the Department of Abdominal Oncology No. 2, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation

ORCID: https://orcid.org/0000-0003-1957-7363, SPIN: 8643-2348, AuthorID: 711165

gevorkyan.000@mail.ruhttps://orcid.org/0000-0002-0118-4935СолдаткинаН. В.SoldatkinaN. V.

Солдаткина Наталья Васильевна – д.м.н., ведущий научный сотрудник отделения общей онкологии, ФГБУ «Национальный медицинский исследовательский центр онкологии» Министерства здравоохранения Российской Федерации, г. Ростов-на-Дону, Российская Федерация

ORCID: https://orcid.org/0000-0002-0118-4935, SPIN: 8392-6679, AuthorID: 440046

Natalya V. Soldatkina – Dr. Sci. (Med.), leading researcher of the Department of General Oncology, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation

ORCID: https://orcid.org/0000-0002-0118-4935, SPIN: 8392-6679, AuthorID: 440046

snv-rnioi@yandex.ruhttps://orcid.org/0000-0002-9426-9662ГусареваМ. А.GusarevaM. A.

Гусарева Марина Александровна – к.м.н., заведующая радиологическим отделением, ФГБУ «Национальный медицинский исследовательский центр онкологии» Министерства здравоохранения Российской Федерации, г. Ростов-на-Дону, Российская Федерация

ORCID: https://orcid.org/0000-0002-9426-9662, SPIN: 9040-5476, AuthorID: 705242

Marina A. Gusareva – Cand. Sci. (Med.), head of the Radiological Department, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation

ORCID: https://orcid.org/0000-0002-9426-9662, SPIN: 9040-5476, AuthorID: 705242

oncorad@mail.ruhttps://orcid.org/0000-0001-7630-1502КошелеваН. Г.KoshelevaN. G.

Кошелева Наталия Геннадьевна – врач-радиотерапевт отделения радиотерапии, ФГБУ «Национальный медицинский исследовательский центр онкологии» Министерства здравоохранения Российской Федерации, г. Ростов-на-Дону, Российская Федерация

ORCID: https://orcid.org/0000-0001-7630-1502

Natalia G. Kosheleva – MD, radiotherapist of the Radiotherapy Department, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation

ORCID: https://orcid.org/0000-0001-7630-1502

natalya.doctorko@yandex.ruhttps://orcid.org/0000-0003-4052-3597СолнцеваА. А.SolntsevaA. A.

Солнцева Анна Анатольевна – к.м.н., врач-радиотерапевт отделения радиотерапии, ФГБУ «Национальный медицинский исследовательский центр онкологии» Министерства здравоохранения Российской Федерации, г. Ростов-на-Дону, Российская Федерация

ORCID: https://orcid.org/0000-0003-4052-3597

Anna A. Solntseva – Cand. Sci. (Med.), MD, radiotherapist at the radiotherapy department, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation

ORCID: https://orcid.org/0000-0003-4052-3597

profcomsaa@mail.ruhttps://orcid.org/0000-0002-4562-1199ПетровД. С.PetrovD. S.

Петров Дмитрий Сергеевич – к.м.н., заместитель генерального директора по хирургии, ФГБУ «Национальный медицинский исследовательский центр онкологии» Министерства здравоохранения Российской Федерации, г. Ростов-на-Дону, Российская Федерация

ORCID: https://orcid.org/0000-0002-4562-1199, SPIN: 1855-3496, AuthorID: 736631

Dmitry S. Petrov – Cand. Sci. (Med.), Deputy CEO of Surgery, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation

ORCID: https://orcid.org/0000-0002-4562-1199, SPIN: 1855-3496, AuthorID: 736631

petrov2010dmitry@yandex.ruhttps://orcid.org/0000-0002-2496-2728СавченкоД. А.SavchenkoD. A.

Савченко Дмитрий Александрович – врач-онколог консультативно-диагностического отделения, ФГБУ «Национальный медицинский исследовательский центр онкологии» Министерства здравоохранения Российской Федерации, г. Ростов-на-Дону, Российская Федерация

ORCID: https://orcid.org/0000-0002-2496-2728

Dmitry A. Savchenko – MD, oncologist of the consultative and diagnostic department, National Medical Research Centre for Oncology, Rostov-on-Don, Russian Federation

ORCID: https://orcid.org/0000-0002-2496-2728

oc.sav.rnd@gmail.comФГБУ «Национальный медицинский исследовательский центр онкологии» Министерства здравоохранения Российской ФедерацииРоссияNational Medical Research Centre for OncologyRussian Federation202428052024522534Copyright © Кит О.И., Бондаренко О.К., Геворкян Ю.А., Солдаткина Н.В., Гусарева М.А., Кошелева Н.Г., Солнцева А.А., Петров Д.С., Савченко Д.А., 20242024Кит О.И., Бондаренко О.К., Геворкян Ю.А., Солдаткина Н.В., Гусарева М.А., Кошелева Н.Г., Солнцева А.А., Петров Д.С., Савченко Д.А.Kit O.I., Bondarenko O.G., Gevorkyan Y.A., Soldatkina N.V., Gusareva M.A., Kosheleva N.G., Solntseva A.A., Petrov D.S., Savchenko D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.cancersp.com/jour/article/view/264Цель исследования

Цель исследования. Изучение функции сфинктерного аппарата у больных раком прямой кишки после химиолучевой терапии с помощью метода аноректальной манометрии высокого разрешения.

Пациенты и методы

Пациенты и методы. В исследовании принимали участие 30 больных раком среднеампулярного и нижнеампулярного отделов прямой кишки, проходивших комбинированное лечение в ФГБУ «Национальный медицинский исследовательский центр онкологии» Министерства здравоохранения Российской Федерации. Пациентам выполнялся курс неоадьювантной дистационной гамма- терапии с применением капецитабина. Для изучения функциональных параметров сфинктерного аппарата выполняли аноректальную манометрию высокого разрешения до начала лечения и через 2 мес. после завершения химиолучевой терапии. Степень выраженности аноректальной дисфункции оценивали с использованием шкалы анальной инконтиненции Wexner.

Результаты

Результаты. После проведения неоадьювантной химиолучевой терапии по данным аноректальной манометрии высокого разрешения показатель среднего давления анального канала в состоянии покоя снижался в 1,4 раза (р < 0,05), а среднее абсолютное давление сжатия при волевом сокращении уменьшалось в 1,2 раза (р = 0,0012). Сравнительная оценка максимального абсолютного давления сжатия на данном этапе лечения не позволила проследить достоверного отличия между его значением до начала лучевой терапии и через 2 мес. после ее завершения (р > 0,05). У 23 пациентов было отмечено увеличение пороговых объемов чувствительности (р = 0,16). Применение шкалы Wexner не показало статистически значимого изменения медианы баллов по результатам опросов пациентов после завершения лечения (5,2 против 5,5 баллов, р > 0,05).

Заключение

Заключение. Лучевая терапия оказывает влияние на аноректальную функцию, что может способствовать возникновению синдрома низкой передней резекции после хирургического лечения. По этой причине в настоящее время необходимо учитывать риски развития аноректальной дисфункции. Не менее важным является использование методов профилактики синдрома низкой передней резекции для больных, получивших комбинированное лечение по поводу рака прямой кишки.

Purpose of the study

Purpose of the study. To study the function of the sphincter in patients with rectal cancer after chemoradiotherapy using the method of high-resolution anorectal manometry.

Patients and methods

Patients and methods. The study included 30 patients with cancer of the middle and lower ampullary rectum, who underwent combined treatment at the National Medical Research Center of Oncology. The patients underwent a course of neoadjuvant gamma radiation therapy using capecitabine. High-resolution anorectal manometry was performed before the start of treatment and 2 months after completion of chemoradiotherapy to study the functional parameters of the sphincter apparatus. The severity of anorectal dysfunction was assessed using the Wexner anal incontinence scale.

Results

Results. According to high-resolution anorectal manometry, the average pressure of the anal canal at rest decreased by 1.4 times (p < 0.05), and the average absolute compression pressure with voluntary contraction decreased by 1.2 times (p = 0.0012) after neoadjuvant chemoradiotherapy. A comparative assessment of the maximum absolute compression pressure at this stage of treatment did not allow us to trace a significant difference between its value before the start of radiation therapy and 2 months after its completion (p > 0.05). An increase in threshold sensitivity volumes was noted in 23 patients (p = 0.16). The use of the Wexner scale didn’t show a statistically significant change in the median scores according to the results of patient surveys following the completion of treatment (5.2 vs. 5.5 points, p > 0.05).

Conclusions

Conclusions. Radiation therapy has an effect on anorectal function, which may contribute to the occurrence of low anterior resection syndrome after surgical treatment. For this reason, it is now necessary to carefully consider the risks of developing anorectal dysfunction. Equally important is the use of methods for the prevention of low anterior resection syndrome for patients who have received combined treatment for rectal cancer.

синдром низкой передней резекциианоректальная манометрия высокого разрешениянеоадьюв антная химиолучевая терапияlow anterior resection syndromehigh-resolution anorectal manometryneoadjuvant chemoradiotherapyReferencesInternational Agency for Research on Cancer, WHO. Global cancer observatory (accessed Jan 11, 2021). Доступно по: https://gco.iarc.fr/. Дата обращения: 31.10.2023.International Agency for Research on Cancer, WHO. Global cancer observatory (accessed Jan 11, 2021). Available at: https://gco.iarc.fr/. Accessed: 31.10.2023.Fokas E, Appelt A, Glynne-Jones R, Beets G, Perez R, Garcia-Aguilar J, et al. International consensus recommendations on key outcome measures for organ preservation after (chemo)radiotherapy in patients with rectal cancer. Nat Rev Clin Oncol. 2021 Dec;18(12):805–816. https://doi.org/10.1038/s41571-021-00538-5Fokas E, Appelt A, Glynne-Jones R, Beets G, Perez R, Garcia-Aguilar J, et al. International consensus recommendations on key outcome measures for organ preservation after (chemo)radiotherapy in patients with rectal cancer. Nat Rev Clin Oncol. 2021 Dec;18(12):805–816. https://doi.org/10.1038/s41571-021-00538-5Beets GL, Figueiredo NF, Beets-Tan RGH. Management of Rectal Cancer Without Radical Resection. Annu Rev Med. 2017 Jan 14;68:169–182. https://doi.org/10.1146/annurev-med-062915-021419Beets GL, Figueiredo NF, Beets-Tan RGH. Management of Rectal Cancer Without Radical Resection. Annu Rev Med. 2017 Jan 14;68:169–182. https://doi.org/10.1146/annurev-med-062915-021419Кит О. И., Геворкян Ю. А., Солдаткина Н. В., Гусарева М. А., Харагезов Д. А., Милакин А. Г. и др. Полный клинический ответ рака прямой кишки на химиолучевое лечение: тактика. Вопросы онкологии. 2017;63(6):838–842. https://doi.org/10.37469/0507-3758-2017-63-6-838-842, EDN: ZXWFEFKit OI, Gevorkyan YuA, Soldatkina NV, Gusareva MA, Kharagezov DA, Milakin AG, et al. Complete clinical response of rectal cancer to chemoradiotherapy: tactics. Voprosy Onkologii. 2017;63(6):838–842. (In Russ.). https://doi.org/10.37469/0507-3758-2017-63-6-838-842, EDN: ZXWFEFDanielle D, Theiss L, Chu D. Epidemiology and Pathophysiology of Low Anterior Resection Syndrome. Seminars in Colon and Rectal Surgery. 2021 Oct 1;32:100844. https://doi.org/10.1016/j.scrs.2021.100844Danielle D, Theiss L, Chu D. Epidemiology and Pathophysiology of Low Anterior Resection Syndrome. Seminars in Colon and Rectal Surgery. 2021 Oct 1;32:100844. https://doi.org/10.1016/j.scrs.2021.100844Li X X, Li X, Fu R, Ng D, Yang T, Zhang Y, et al. Efficacy of Neoadjuvant Therapy in Improving Long-Term Survival of Patients with Resectable Rectal Cancer: A Meta-Analysis. Anticancer Agents Med Chem. 2022;22(6):1068–1079. https://doi.org/10.2174/1871520621666210726134809Li X X, Li X, Fu R, Ng D, Yang T, Zhang Y, et al. Efficacy of Neoadjuvant Therapy in Improving Long-Term Survival of Patients with Resectable Rectal Cancer: A Meta-Analysis. Anticancer Agents Med Chem. 2022;22(6):1068–1079. https://doi.org/10.2174/1871520621666210726134809Bohlok A, Mercier C, Bouazza F, Galdon MG, Moretti L, Donckier V, et al. The burden of low anterior resection syndrome on quality of life in patients with mid or low rectal cancer. Support Care Cancer. 2020 Mar;28(3):1199–1206. https://doi.org/10.1007/s00520-019-04901-2Bohlok A, Mercier C, Bouazza F, Galdon MG, Moretti L, Donckier V, et al. The burden of low anterior resection syndrome on quality of life in patients with mid or low rectal cancer. Support Care Cancer. 2020 Mar;28(3):1199–1206. https://doi.org/10.1007/s00520-019-04901-2Pape E, Pattyn P, Van Hecke A, Somers N, Van de Putte D, Ceelen W, et al. Impact of low anterior resection syndrome (LARS) on the quality of life and treatment options of LARS - A cross sectional study. Eur J Oncol Nurs. 2021 Feb;50:101878. https://doi.org/10.1016/j.ejon.2020.101878Pape E, Pattyn P, Van Hecke A, Somers N, Van de Putte D, Ceelen W, et al. Impact of low anterior resection syndrome (LARS) on the quality of life and treatment options of LARS - A cross sectional study. Eur J Oncol Nurs. 2021 Feb;50:101878. https://doi.org/10.1016/j.ejon.2020.101878He S, Zhang J, Wang R, Li L, Shi L, Ren D, et al. Impact of long-course neoadjuvant radiation on postoperative low anterior resection syndrome and stoma status in rectal cancer: long-term functional follow-up of a randomized clinical trial. BJS Open. 2022 Nov 2;6(6):zrac127. https://doi.org/10.1093/bjsopen/zrac127He S, Zhang J, Wang R, Li L, Shi L, Ren D, et al. Impact of long-course neoadjuvant radiation on postoperative low anterior resection syndrome and stoma status in rectal cancer: long-term functional follow-up of a randomized clinical trial. BJS Open. 2022 Nov 2;6(6):zrac127. https://doi.org/10.1093/bjsopen/zrac127Loos M, Quentmeier P, Schuster T, Nitsche U, Gertler R, Keerl A, et al. Effect of preoperative radio(chemo)therapy on long-term functional outcome in rectal cancer patients: a systematic review and meta-analysis. Ann Surg Oncol. 2013 Jun;20(6):1816–1828. https://doi.org/10.1245/s10434-012-2827-zLoos M, Quentmeier P, Schuster T, Nitsche U, Gertler R, Keerl A, et al. Effect of preoperative radio(chemo)therapy on long-term functional outcome in rectal cancer patients: a systematic review and meta-analysis. Ann Surg Oncol. 2013 Jun;20(6):1816–1828. https://doi.org/10.1245/s10434-012-2827-zIhnát P, Slívová I, Tulinsky L, Ihnát Rudinská L, Máca J, Penka I. Anorectal dysfunction after laparoscopic low anterior rectal resection for rectal cancer with and without radiotherapy (manometry study). J Surg Oncol. 2018 Mar;117(4):710–716. https://doi/org/10.1002/jso.24885Ihnát P, Slívová I, Tulinsky L, Ihnát Rudinská L, Máca J, Penka I. Anorectal dysfunction after laparoscopic low anterior rectal resection for rectal cancer with and without radiotherapy (manometry study). J Surg Oncol. 2018 Mar;117(4):710–716. https://doi/org/10.1002/jso.24885Sandberg S, Asplund D, Bisgaard T, Bock D, González E, Karlsson L, et al. Low anterior resection syndrome in a Scandinavian population of patients with rectal cancer: a longitudinal follow-up within the QoLiRECT study. Colorectal Dis. 2020 Oct;22(10):1367–1378. https://doi.org/10.1111/codi.150953Sandberg S, Asplund D, Bisgaard T, Bock D, González E, Karlsson L, et al. Low anterior resection syndrome in a Scandinavian population of patients with rectal cancer: a longitudinal follow-up within the QoLiRECT study. Colorectal Dis. 2020 Oct;22(10):1367–1378. https://doi.org/10.1111/codi.150953Кит О. И., Геворкян Ю. А., Солдаткина Н. В., Колесников Е. Н., Аверкин М. А., Гусарева М. А. Аноректальная манометрия высокого разрешения в исследовании аноректальной функции после комбинированного лечения рака прямой кишки. Вопросы онкологии. 2020;66(4):385–390. https://doi.org/10.37469/0507-3758-2020-66-4-385-390, EDN: ZFEFMXKit OI, Gevorkyan YuA, Soldatkina NV, kolesnikov EN, averkin MA, Gusareva MA, et al. High-resolution anorectal manometry in testing anorectal function after combination treatment for rectal cancer. Voprosy Onkologii. 2020;66(4):385–390. (In Russ.). https://doi.org/10.37469/0507-3758-2020-66-4-385-390, EDN: ZFEFMXScott SM, Carrington EV. The London Classification: Improving Characterization and Classification of Anorectal Function with Anorectal Manometry. Curr Gastroenterol Rep. 2020 Sep 15;22(11):55. Published 2020 Sep 15. https://doi.org/10.1007/s11894-020-00793-zScott SM, Carrington EV. The London Classification: Improving Characterization and Classification of Anorectal Function with Anorectal Manometry. Curr Gastroenterol Rep. 2020 Sep 15;22(11):55. Published 2020 Sep 15. https://doi.org/10.1007/s11894-020-00793-zDeng Y, Chi P, Lan P, Wang L, Chen W, Cui L, et al. Neoadjuvant Modified FOLFOX6 With or Without Radiation Versus Fluorouracil Plus Radiation for Locally Advanced Rectal Cancer: Final Results of the Chinese FOWARC Trial. J Clin Oncol. 2019 Dec 1;37(34):3223–3233. https://doi.org/10.1200/JCO.18.02309Deng Y, Chi P, Lan P, Wang L, Chen W, Cui L, et al. Neoadjuvant Modified FOLFOX6 With or Without Radiation Versus Fluorouracil Plus Radiation for Locally Advanced Rectal Cancer: Final Results of the Chinese FOWARC Trial. J Clin Oncol. 2019 Dec 1;37(34):3223–3233. https://doi.org/10.1200/JCO.18.02309Mariotto R, Herbella FAM, Andrade VLÂ, Schlottmann F, Patti MG. VALIDATION OF A NEW WATER-PERFUSED HIGH-RESOLUTION MANOMETRY SYSTEM. Arq Bras Cir Dig. 2021;33(4):e1557. https://doi.org/10.1590/0102-672020200004e1557Mariotto R, Herbella FAM, Andrade VLÂ, Schlottmann F, Patti MG. VALIDATION OF A NEW WATER-PERFUSED HIGH-RES- OLUTION MANOMETRY SYSTEM. Arq Bras Cir Dig. 2021;33(4):e1557. https://doi.org/10.1590/0102-672020200004e1557Ciriza de Los Ríos C, Mínguez M, Remes-Troche JM, Lacima G. High-resolution and high-definition anorectal manometry: rediscovering anorectal function. Rev Esp Enferm Dig. 2018 Dec;110(12):794–805. https://doi.org/10.17235/reed.2018.5705/2018Ciriza de Los Ríos C, Mínguez M, Remes-Troche JM, Lacima G. High-resolution and high-definition anorectal manometry: rediscovering anorectal function. Rev Esp Enferm Dig. 2018 Dec;110(12):794–805. https://doi.org/10.17235/reed.2018.5705/2018Rosa C, Di Tommaso M, Caravatta L, Vinciguerra A, Augurio A, Perrotti F, et al. Assessment of bowel and anal sphincter function after neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Tumori. 2018;104(2):121–127. https://doi.org/10.1177/0300891618765580Rosa C, Di Tommaso M, Caravatta L, Vinciguerra A, Augurio A, Perrotti F, et al. Assessment of bowel and anal sphincter function after neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Tumori. 2018;104(2):121–127. https://doi.org/10.1177/0300891618765580Seo M, Joo S, Jung KW, Song EM, Rao SSC, Myung SJ. New Metrics in High-Resolution and High-Definition Anorectal Manometry. Curr Gastroenterol Rep. 2018 Nov 5;20(12):57. https://doi.org/10.1007/s11894-018-0662-5Seo M, Joo S, Jung KW, Song EM, Rao SSC, Myung SJ. New Metrics in High-Resolution and High-Definition Anorectal Manometry. Curr Gastroenterol Rep. 2018 Nov 5;20(12):57. https://doi.org/10.1007/s11894-018-0662-5Miacci FLC, Guetter CR, Moreira PH, Sartor MC, Savio MC, Baldin Júnior A, et al. Predictive factors of low anterior resection syndrome following anterior resection of the rectum. Rev Col Bras Cir. 2020;46(6):e20192361. https://doi.org/10.1590/0100-6991e-20192361Miacci FLC, Guetter CR, Moreira PH, Sartor MC, Savio MC, Baldin Júnior A, et al. Predictive factors of low anterior resection syndrome following anterior resection of the rectum. Rev Col Bras Cir. 2020;46(6):e20192361. https://doi.org/10.1590/0100-6991e-20192361Christensen P, Im Baeten C, Espín-Basany E, Martellucci J, Nugent KP, Zerbib F, et al. Management guidelines for low anterior resection syndrome – the MANUEL project. Colorectal Dis. 2021 Feb;23(2):461–475. https://doi.org/10.1111/codi.15517Christensen P, Im Baeten C, Espín-Basany E, Martellucci J, Nugent KP, Zerbib F, et al. Management guidelines for low anterior resection syndrome - the MANUEL project. Colorectal Dis. 2021 Feb;23(2):461–475. https://doi.org/10.1111/codi.15517Фоменко О. Ю., Кашников В. Н., Алексеев М. В., Веселов А. В., Белоусова С. В., Алешин Д. В. и др. Реабилитационная программа для больных раком прямой кишки с синдромом низкой передней резекции. Вопросы курортологии, физиотерапии и лечебной физической культуры. 2020;97(5):52–59. https://doi.org/10.17116/kurort20209705152, EDN: GGNNOKFomenko OYu, Kashnikov VN, Alekseev MV, Veselov AV, Belousova SV, Aleshin DV, et al. Rehabilitation program for patients with rectal cancer with low anterior resection syndrome. Problems of Balneology, Physiotherapy and Exercise Therapy.. 2020;97(5):52–59. (In Russ.). https://doi.org/10.17116/kurort20209705152, EDN: GGNNOKLuo BJ, Zheng MC, Xia Y, Ying Z, Peng JH, Li LR, et al. Assessment of defecation function after sphincter-saving resection for mid to low rectal cancer: A cross-sectional study. Eur J Oncol Nurs. 2021 Dec;55:102059. https://doi.org/10.1016/j.ejon.2021.102059Luo BJ, Zheng MC, Xia Y, Ying Z, Peng JH, Li LR, et al. Assessment of defecation function after sphincter-saving resection for mid to low rectal cancer: A cross-sectional study. Eur J Oncol Nurs. 2021 Dec;55:102059. https://doi.org/10.1016/j.ejon.2021.102059Nguyen TH, Chokshi RV. Low Anterior Resection Syndrome. Curr Gastroenterol Rep. 2020 Aug 4;22(10):48. https://doi.org/10.1007/s11894-020-00785-zNguyen TH, Chokshi RV. Low Anterior Resection Syndrome. Curr Gastroenterol Rep. 2020 Aug 4;22(10):48. https://doi.org/10.1007/s11894-020-00785-zKrol R, Smeenk RJ, van Lin ENJT, Yeoh EEK, Hopman WPM. Systematic review: anal and rectal changes after radiotherapy for prostate cancer. Int J Colorectal Dis. 2014 Mar;29(3):273–283. https://doi.org/10.1007/s00384-013-1784-8Krol R, Smeenk RJ, van Lin ENJT, Yeoh EEK, Hopman WPM. Systematic review: anal and rectal changes after radiotherapy for prostate cancer. Int J Colorectal Dis. 2014 Mar;29(3):273–283. https://doi.org/10.1007/s00384-013-1784-8Ammann K, Kirchmayr W, Klaus A, Mühlmann G, Kafka R, Oberwalder M, et al. Impact of neoadjuvant chemoradiation on anal sphincter function in patients with carcinoma of the midrectum and low rectum. Arch Surg. 2003 Mar;138(3):257–261. https://doi.org/10.1001/archsurg.138.3.257Ammann K, Kirchmayr W, Klaus A, Mühlmann G, Kafka R, Oberwalder M, et al. Impact of neoadjuvant chemoradiation on anal sphincter function in patients with carcinoma of the midrectum and low rectum. Arch Surg. 2003 Mar;138(3):257–261. https://doi.org/10.1001/archsurg.138.3.257De Nardi P, Testoni SGG, Corsetti M, Andreoletti H, Giollo P, Passaretti S, et al. Manometric evaluation of anorectal function in patients treated with neoadjuvant chemoradiotherapy and total mesorectal excision for rectal cancer. Dig Liver Dis. 2017 Jan;49(1):91–97. https://doi.org/10.1016/j.dld.2016.09.005De Nardi P, Testoni SGG, Corsetti M, Andreoletti H, Giollo P, Passaretti S, et al. Manometric evaluation of anorectal function in patients treated with neoadjuvant chemoradiotherapy and total mesorectal excision for rectal cancer. Dig Liver Dis. 2017 Jan;49(1):91–97. https://doi.org/10.1016/j.dld.2016.09.005Fratta CL, Pinheiro LV, Costa FO, Magro DO, Martinez CAR, Coy CSR. Study of anorectal physiology pre and pos neoadjuvant therapy for rectal cancer by anorectal manometry and jorge-wexner score. Arq Gastroenterol. 2022;59(3):334–339. https://doi.org/10.1590/S0004-2803.202203000-61Fratta CL, Pinheiro LV, Costa FO, Magro DO, Martinez CAR, Coy CSR. Study of anorectal physiology pre and pos neoadjuvant therapy for rectal cancer by anorectal manometry and jorge-wexner score. Arq Gastroenterol. 2022;59(3):334–339. https://doi.org/10.1590/S0004-2803.202203000-61Jimenez-Gomez LM, Espin-Basany E, Trenti L, Martí-Gallostra M, Sánchez-García JL, Vallribera-Valls F, et al. Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer. Colorectal Dis. 2017 Sep 29. https://doi.org/10.1111/codi.13901Jimenez-Gomez LM, Espin-Basany E, Trenti L, Martí-Gallostra M, Sánchez-García JL, Vallribera-Valls F, et al. Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer. Colorectal Dis. 2017 Sep 29. https://doi.org/10.1111/codi.13901Kim JG, Song KD, Cha DI, Kim HC, Yu JI. Indistinguishable T2/T3-N0 rectal cancer on rectal magnetic resonance imaging: comparison of surgery-first and neoadjuvant chemoradiation therapy-first strategies. Int J Colorectal Dis. 2018 Oct;33(10):1359–1366. https://doi.org/10.1007/s00384-018-3131-6Kim JG, Song KD, Cha DI, Kim HC, Yu JI. Indistinguishable T2/T3-N0 rectal cancer on rectal magnetic resonance imaging: comparison of surgery-first and neoadjuvant chemoradiation therapy-first strategies. Int J Colorectal Dis. 2018 Oct;33(10):1359–1366. https://doi.org/10.1007/s00384-018-3131-6Varma JS, Smith AN, Busuttil A. Function of the anal sphincters after chronic radiation injury. Gut. 1986 May;27(5):528–533. https://doi.org/10.1136/gut.27.5.528Varma JS, Smith AN, Busuttil A. Function of the anal sphincters after chronic radiation injury. Gut. 1986 May;27(5):528– 533. https://doi.org/10.1136/gut.27.5.528Da Silva GM, Berho M, Wexner SD, Efron J, Weiss EG, Nogueras JJ, et al. Histologic analysis of the irradiated anal sphincter. Dis Colon Rectum. 2003 Nov;46(11):1492–1497. https://doi.org/10.1007/s10350-004-6800-1Da Silva GM, Berho M, Wexner SD, Efron J, Weiss EG, Nogueras JJ, et al. Histologic analysis of the irradiated anal sphincter. Dis Colon Rectum. 2003 Nov;46(11):1492–1497. https://doi.org/10.1007/s10350-004-6800-1Rahbari NN, Elbers H, Askoxylakis V, Motschall E, Bork U, Büchler MW, et al. Neoadjuvant radiotherapy for rectal cancer: meta-analysis of randomized controlled trials. Ann Surg Oncol. 2013 Dec;20(13):4169–4182. https://doi.org/10.1245/s10434-013-3198-9Rahbari NN, Elbers H, Askoxylakis V, Motschall E, Bork U, Büchler MW, et al. Neoadjuvant radiotherapy for rectal cancer: meta-analysis of randomized controlled trials. Ann Surg Oncol. 2013 Dec;20(13):4169–4182. https://doi.org/10.1245/s10434-013-3198-9Кит О. И., Геворкян Ю. А., Гусарева М. А., Розенко Л. Я., Солдаткина Н. В., Харагезов Д. А. и др. Преимущества короткого и пролонгированного курса предоперационной лучевой терапии в лечении рака прямой кишки. Вопросы онкологии. 2018;64(1):110–115. https://doi.org/10.37469/0507-3758-2018-64-1-110-115, EDN: XMLHKXKit OI, Gevorkyan YuA, Gusareva MA, Rozenko LYa, Soldatkina NV, Kharagezov DA, et al. Advantages of a short and prolonged course of preoperative radiation therapy in the treatment of rectal cancer. Voprosy Onkologii. 2018;64(1):110–115. (In Russ.). https://doi.org/10.37469/0507-3758-2018-64-1-110-115, EDN: XMLHKXLundby L, Krogh K, Jensen VJ, Gandrup P, Qvist N, Overgaard J, et al. Long-term anorectal dysfunction after postoperative radiotherapy for rectal cancer. Dis Colon Rectum. 2005 Jul;48(7):1343–1352. https://doi.org/10.1007/s10350-005-0049-1Lundby L, Krogh K, Jensen VJ, Gandrup P, Qvist N, Overgaard J, et al. Long-term anorectal dysfunction after postoperative radiotherapy for rectal cancer. Dis Colon Rectum. 2005 Jul;48(7):1343–1352. https://doi.org/10.1007/s10350-005-0049-1Faaborg PM, Haas S, Liao D, Ploen J, Jakobsen A, Rahr HB, et al. Long-term anorectal function in rectal cancer patients treated with chemoradiotherapy and endorectal brachytherapy. Colorectal Dis. 2021 Sep;23(9):2311–2319. https://doi.org/10.1111/codi.15692Faaborg PM, Haas S, Liao D, Ploen J, Jakobsen A, Rahr HB, et al. Long-term anorectal function in rectal cancer patients treated with chemoradiotherapy and endorectal brachytherapy. Colorectal Dis. 2021 Sep;23(9):2311–2319. https://doi.org/10.1111/codi.15692Van der Sande ME, Hupkens BJP, Berbée M, van Kuijk SMJ, Maas M, Melenhorst J, et al. Impact of radiotherapy on anorectal function in patients with rectal cancer following a watch and wait programme. Radiother Oncol. 2019 Mar;132:79–84. https://doi.org/10.1016/j.radonc.2018.11.017Van der Sande ME, Hupkens BJP, Berbée M, van Kuijk SMJ, Maas M, Melenhorst J, et al. Impact of radiotherapy on anorectal function in patients with rectal cancer following a watch and wait programme. Radiother Oncol. 2019 Mar;132:79–84. https://doi.org/10.1016/j.radonc.2018.11.017De Nardi P, Testoni SGG, Corsetti M, Andreoletti H, Giollo P, Passaretti S, et al. Manometric evaluation of anorectal function in patients treated with neoadjuvant chemoradiotherapy and total mesorectal excision for rectal cancer. Dig Liver Dis. 2017 Jan;49(1):91–97. https://doi.org/10.1016/j.dld.2016.09.005De Nardi P, Testoni SGG, Corsetti M, Andreoletti H, Giollo P, Passaretti S, et al. Manometric evaluation of anorectal function in patients treated with neoadjuvant chemoradiotherapy and total mesorectal excision for rectal cancer. Dig Liver Dis. 2017 Jan;49(1):91–97. https://doi.org/10.1016/j.dld.2016.09.005

The authors declare that there are no conflicts of interest present.