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Meta-Analysis
. 2024 Aug;110(4):284-294.
doi: 10.1177/03008916241256544. Epub 2024 May 31.

Effect of neoadjuvant chemoradiation on anorectal function assessed with anorectal manometry: A systematic review and meta-analysis

Pamela Milito  1   2 , Guglielmo Niccolò Piozzi  2   3 , Mohammad Iqbal Hussain  4 , Tommaso A Dragani  5 , Luca Sorrentino  2 , Maurizio Cosimelli  2 , Marcello Guaglio  2 , Luigi Battaglia  2
Affiliations
Meta-Analysis

Effect of neoadjuvant chemoradiation on anorectal function assessed with anorectal manometry: A systematic review and meta-analysis

Pamela Milito et al. Tumori. 2024 Aug.

Abstract

Aim: Improvement in oncological survival for rectal cancer increases attention to anorectal dysfunction. Diagnostic questionnaires can evaluate quality of life but are subjective and dependent on patients' compliance. Anorectal manometry can objectively assess the continence mechanism and identify functional sphincter weakness and rectal compliance. Neoadjuvant chemoradiotherapy is presumed to affect anorectal function. We aim to assess anorectal function in rectal cancer patients who undergo total mesorectal excision, with or without neoadjuvant chemoradiation, using anorectal manometry measurements.

Method: MEDLINE, Embase, and Cochrane databases were searched for studies comparing perioperative anorectal manometry between neoadjuvant chemoradiation and upfront surgery for rectal cancers. Primary outcomes were resting pressure, squeeze pressure, sensory threshold volume and maximal tolerable volume.

Results: Eight studies were included in the systematic review, of which seven were included for metanalysis. 155 patients (45.3%) had neoadjuvant chemoradiation before definitive surgery, and 187 (54.6%) underwent upfront surgery. Most patients were male (238 vs. 118). The standardized mean difference of mean resting pressure, mean and maximum squeeze pressure, maximum resting pressure, sensory threshold volume, and maximal tolerable volume favored the upfront surgery group but without statistical significance.

Conclusion: Currently available evidence on anorectal manometry protocols failed to show any statistically significant differences in functional outcomes between neoadjuvant chemoradiation and upfront surgery. Further large-scale prospective studies with standardized neoadjuvant chemoradiation and anorectal manometry protocols are needed to validate these findings.

Keywords: Anorectal manometry; LARS; anal function; neoadjuvant chemoradiotherapy.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA statement flow diagram, summary of systematic search and review.
Figure 2.
Figure 2.
Random funnel plot for Maximum Resting Pressure (MaxRP, A), Maximum Squeeze Pressure (MaxSP, B), Mean Resting Pressure (MRP, C), Mean Squeeze Pressure (MSP, D), Maximal Tolerable Volume (MTV, E), and Sensory Threshold Volume (STV, F).
See this image and copyright information in PMC

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