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PubMed2000

In vitro flow quantification with contrast power Doppler imaging.

To evaluate the effectiveness of contrast harmonic (power Doppler imaging) as an ultrasonic modality to quantify flow, an in vitro model of perfusion was studied using Optison, a second-generation ultrasound (US) contrast agent. The in vitro model was made of two dialysis cartridges placed parallel and allowed absolute and relative flow quantification on both tube (entry lines) and tissue (cartridges) simulations. Video intensity curves were generated using intermittent harmonic power Doppler imaging after bolus injection of contrast. Correlation between flow and different parameters extracted from time-intensity curves and previously defined as indicators of flow was established for both tissue and entry lines, for flow rates ranging from 0 to 400 mL/min. Single-compartment equations were also tested on the model. A good correlation for the tissue model was observed between absolute flow and onset time (O), time to maximal enhancement (TME), peak intensity (P), area under the curve (AUC), and maximal ascending slope (S) parameters, with a r = 0.94, 0.94, 0.91, 0.92 and 0.92, respectively. The correlation for O, TME, P and AUC parameters was r = 0.86, 0.90, 0.78 and 0.82, respectively for entry lines. The correlation for tissue model and entry line was slightly improved when comparing flow ratios with peak ratios (P1/P2) and slope ratios (S1/S2) (r = 0.95 and 0.94). Flow calculation using the gradient-relationship method also showed a good correlation (r = 0.88) with the experimental flow. The results obtained indicated that absolute and relative quantification of flow using PDI is feasible in tube and tissue models. Several clinical applications, namely in myocardial, hepatic and renal artery studies, could be derived from these results.

Albumins↗
PubMed2003

Radiotherapy does not compensate for positive resection margins in rectal cancer patients: report of a multicenter randomized trial.

PURPOSE: Circumferential resection margin (CRM) involvement is a prognostic factor for local recurrence in rectal cancer. In a randomized trial comparing preoperative radiotherapy (5 x 5 Gy), followed by total mesorectal excision (TME) with TME alone, we demonstrated the beneficial effect of short-term preoperative radiotherapy on local recurrences. Here we evaluate the effect of radiotherapy on local recurrence rates in patients with different CRM involvements. METHODS AND MATERIALS: Circumferential margins were defined as positive (< or =1 mm), narrow (1.1-2 mm), or wide (>2 mm). Postoperative radiotherapy was mandatory for surgery-only patients with a positive CRM, but was not always administered and enabled us to compare local recurrence rates for patients with or without postoperative radiotherapy. Furthermore, the effect of preoperative radiotherapy was assessed in the different margin groups. RESULTS: Of 120 patients in the surgery-only group with a positive CRM, 47% received postoperative radiotherapy. There was no difference in the local recurrence rate between the irradiated and nonirradiated patients (17.3% vs. 15.7%, p = 0.98). Preoperative radiotherapy was effective in patients with a narrow CRM (0% vs. 14.9%, p = 0.02) or wide CRM (0.9 vs. 5.8%, p < 0.0001), but not in patients with positive margins (9.3% vs. 16.4%, p = 0.08). CONCLUSION: Preoperative hypofractionated radiotherapy has a beneficial effect in patients with wide or narrow resection margins, but cannot compensate for microscopically irradical resections resulting in positive margins.

Adenocarcinoma↗
PubMed2003

Late toxicity after short course preoperative radiotherapy and total mesorectal excision for resectable rectal cancer.

AIMS: The late toxicity of short-course preoperative radiotherapy (SCPRT) after total mesorectal excision (TME) in resectable rectal cancer has not been adequately documented. The acute toxicity in a series of 176 consecutive patients has been previously reported. In this study, the late toxicity in the same cohort is presented. MATERIALS AND METHODS: Side-effects occurring more than 3 months after the start of SCPRT were graded using the EORTC/RTOG late radiation toxicity system. We performed multivariate analysis to identify associated factors. RESULTS: Of 176 patients, 15 died within 3 months of SCPRT and five patients were lost to follow-up. One hundred and fifty-six patients were assessable at a median follow-up interval of 41 months: severe (grade 3-4) toxicity was seen in 20 patients (13%), of which 13 were gastrointestinal (8%); three urological (2%); three thromboembolic (2%), and one musculoskeletal (1%). On multivariate analysis, abdomino-perineal (AP) resection (P < 0.02) was associated with a lower risk of grade 3-4 toxicity. CONCLUSIONS: In this retrospective study, the rate of late grade 3-4 toxicity after SCPRT and TME was 13%. Although AP resection seems to be associated with a lower incidence of late toxicity, this could be counterbalanced by the impact of a stoma on quality of life. These factors should be considered when determining the optimal management of resectable rectal cancers.

Aged↗
PubMed2002

Developments and quality assurance in rectal cancer surgery.

One of the main problems in the treatment of rectal cancer is the development of local recurrences. In the last decades, major improvements have been realized in the surgical treatment of rectal cancer. The introduction of TME-surgery has led to a large reduction in local recurrence rates and improved survival. TME-based operations are now established as the standard of care for rectal cancer, and should form the basis for trials concerning the role of (neo)adjuvant therapy. However, training and quality control are prerequisites to obtain good results in all surgeons' hands. Furthermore, standardization in the description of operations and reporting of pathology specimens should be implemented as important features of quality control. In general, it is thought that high volume and specialist care produces superior results to low volume and non-specialist care, especially for those less frequent forms of cancer and in technically difficult operations, like those for rectal cancer. However, limiting the performance of rectal cancer surgery to highly specialized surgeons or to only those general surgeons who perform more than a certain volume is impractical in view of the prevalence of rectal cancer. This article reviews developments in the treatment of especially mobile rectal cancer and pays attention to variability in outcomes and quality assurance of surgery.

Colorectal Surgery↗
PubMed2002

Transanal endoscopic microsurgery for rectal cancer.

If curation is intended for rectal cancer, total mesorectal excision with autonomic nerve preservation (TME) is the gold standard. Transanal resection is tempting because of low mortality and morbidity rates. However, inferior tumour control, provoked by the limitations of the technique, resulted in its cautious application and use mainly for palliation. Transanal endoscopic microsurgery (TEM) is a minimal invasive technique for the local resection of rectal tumours. It is a one-port system, introduced transanally. An optical system with a 3D-view, 6-fold magnification and resolution as the human eye, together with the creation of a stabile pneumorectum, and specially designed instruments allow full-thickness excision under excellent view and a proper histological examination. The technique can also be applied for larger and more proximal tumours. Mortality, morbidity as well as incomplete excision rates are minimal. Local recurrence and survival rates seem comparable to TME in early rectal cancer. TEM is the method of choice when local resection of rectal cancer is indicated. Results justify a re-evaluation of the indications for the local excision of rectal cancer with a curative intent.

Adult↗
PubMed2002

The circumferential margin in rectal cancer. Recommendations based on the Dutch Total Mesorectal Excision Study.

A very low local recurrence rate in rectal cancer is possible with optimal staging, preoperative radiotherapy and the use of total mesorectal excision (TME). Data from a study where patients were randomised for preoperative radiotherapy (or not) and complete removal of the tumour and mesorectum were examined. A consensus meeting was held to discuss the data in which the following guidelines for implementation were made. Adequate imaging is necessary to increase the likelihood of a R0 resection. Advances cases (possible margin to the endopelvicfascie less than 2 mm) need a long course of preoperative radiotherapy. Primary resectable cases benefit from a short course of radiation directly followed by surgery. A continuous quality control of surgery is mandatory in order to maintain the skill for a TME. A complete pathology report is important for the quality control of the surgical treatment and to predict the outcome of treatment. All of the involved disciplines in the diagnosis and treatment of rectal cancer should focus on the circumferential margin to guide for optimal treatment. Multidisciplinary teams are important for the achievement of optimal treatment planning of rectal cancer patients and maintenance of the highest level of quality control.

Colorectal Surgery↗
PubMed2005

Long-term morbidity following short-course, pre-operative radiotherapy and total mesorectal excision for rectal cancer.

AIM: Short-course pre-operative radiotherapy (SCPRT) and total mesorectal excision (TME) have been shown to reduce the rate of relapse and improve survival in patients with rectal cancer. Concerns about morbidity have limited its application in some centres. The aim of this study was to assess long-term toxicity of pre-operative RT in patients with rectal cancer. METHODS: Permanent toxicity was assessed in 20 patients who were alive >12 months after pre-operative RT (25Gy/ 5#), using a validated LENT SOMA scoring system. Ten patients with rectal cancer who had been operated on >12 months ago, but had not received pre-operative RT were assessed similarly. RESULTS: Patients who had received SCPRT appeared to have a significantly higher rectal toxicity, urinary and male sexual dysfunction, compared with the controls. No significant difference was noted in female sexual dysfunction. CONCLUSION: The combination of pre-operative RT and TME appears to be associated with significant long-term toxicity. Better methods of staging the tumours may improve selection of patients for SCPRT.

Adenocarcinoma↗
PubMed1996

Stoichiometric and substoichiometric inhibition of tubulin self-assembly by colchicine analogues.

The mechanism of the stoichiometric and substoichiometric inhibitions of tubulin self-assembly by several structural analogues of colchicine (COL) was investigated. The inhibition data were analyzed in terms of a simple model that takes into consideration Kg, the normal microtubule growth constant, equal to Cr-1 (Cr is the critical concentration for microtubule formation), and Kb, the binding constant of the drug to tubulin. In this manner, the value of the microtubule inhibition constant (Ki), which is the binding constant of the tubulin-drug complex to the end of a growing microtubule (which stops the microtubule growth), was determined. The results of the analysis of microtubule inhibition by the various colchicine analogues show that all the inhibitions can be expressed reasonably by this model. The strongest inhibitors found were colchicine (COL), allocolchicine (ALLO), and the biphenyl keto analogue 2,3,4-trimethoxy-4'-acetyl-1,1'-biphenyl (TKB), which had essentially identical values of Ki = (2.1 +/- 0.3) x 10(6) M(-1). MTC, the two-ring analogue of colchicine, was weaker (Ki = 5.6 x 10(5) M(-1). A most striking result was that tropolone methyl ether (TME), which is ring C of COL, and which binds very weakly to tubulin (Kb = 3.5 x 10(2) M(-1)), is a substoichiometric inhibitor. Its Ki value of 8.7 x 10(5) M(-1) makes it identical in strength to MTC, suggesting that ring A makes little or no contribution to the induction of assembly inhibition. The three biphenyls, which bind to tubulin with similar affinity, spanned the spectrum from strong substoichiometric inhibition (TKB) to stoichiometric inhibition for 2,3,4-trimethoxy-4'-carbomethoxy-1,1'-biphenyl (TCB) and an intermediate mode for the methoxy derivative 2,3,4,4'-tetramethoxy-1,1'-biphenyl (TMB). The extent of tubulin bound to drugs at 50% inhibition (r) was ca. 2% for TKB, ALLO, and COL, i.e. one liganded tubulin for every 40-50 molecules of free protein (substoichiometric). This ratio was 1:1.5 for TCB (stoichiometric) and 1:6 for TMB (intermediate). For TME, which is a single ring compound, it was 1:25. The progression of the stoichiometries varied directly with Ki and was totally unrelated to the values of Kb, which indicated the control of the stoichiometry by Ki and the close thermodynamic linkage between r and Ki. Comparison of the inhibitory capabilities of the various drugs identified the need for strong substoichiometric inhibition of a carbonyl group on ring C or C'. Furthermore, this group must be properly oriented by interaction with the protein or by the structural rigidity imparted by ring B, as in ALLO. The simple linked equilibrium model developed in this paper permits the alignment of drugs along a continuum that ranges from stoichiometric to strong substoichiometric modes of microtubule inhibition. Furthermore, it shows that the previously identified two classes are the two ends of a monotonously progressing spectrum described by a single mechanism of action.

Animals↗
PubMed2003

Convenient scaffold for forming heteroporphyrin arrays in aqueous media.

A new methodology for preparing heteroporphyrin arrays in aqueous solution has been presented. The present method is based on the extremely strong ability of heptakis(2,3,6-tri-O-methyl)-beta-cyclodextrin (TMe-beta-CD) to include 5,10,15,20-tetrakis(p-substituted-phenyl)porphyrins (Por) affording trans-type 1:2 complexes of the porphyrins and TMe-beta-CD. Two different Por-per-O-methylated beta-CD (per-Me-beta-CD) conjugates were synthesized. Conjugate 2 was prepared by an S(N)2 reaction of 5,10,15,20-tetrakis(p-hydroxyphenyl)porphyrin and per-O-methylated beta-cyclodextrin having one primary OTs group. Four per-Me-beta-CD moieties are attached to the meso positions of 2. Conjugate 3, synthesized from 5-(p-hydroxyphenyl)-10,15,20-tris(3,5-dicarboxyphenyl)porphyrin and monotosylated per-O-methylated beta-cyclodextrin, has one per-Me-beta-CD moiety at the periphery of the porphyrin. Conjugate 2 yields a stable 1:4 complex with the zinc complex of 5-phenyl-10,15,20-tris(3,5-dicarboxyphenyl)porphyrin (8) in the dissociated form. In this system, the energy transfer from photoexcited Zn-8 to free base 2 occurs with 85% efficiency. Conjugate 3 forms a very stable 1:1 complex with Zn-8 (K = (7.0 +/- 0.3) x 10(5) dm(3) mol(-1)) with an energy transfer efficiency (93%) larger than that obtained in the case of 2. The structure of the 3-Zn-8 complex, which can account for the efficient energy transfer, was deduced from (1)H NMR spectroscopy. Intramolecular fluorescence quenching of 2 and 3 by Fe(III)-8 also occurred through an electron-transfer process as the main quenching mechanism. The present method is a very simple and convenient means to construct various heteroporphyrin arrays in aqueous solution.

Cyclodextrins↗
PubMed1998

Oxidative transformations of 1-nitropyrene under simulated environmental conditions.

The oxidation of 1-nitropyrene (1-NP), adsorbed on silica gel, with dimethyldioxirane (DMD) leads to the formation of 1-nitropyrene 4,5-oxide and 1-nitropyrene 9,10-oxide in a ratio of 74/26 (4,5-oxide/9,10-oxide). When the adsorbed 1-NP is exposed to the products of the gas-phase reaction of tetramethylethylene (TME) with ozone at -40 degrees C, the same oxides are produced in a ratio of 72/28. The fact that the ratio of the oxides is essentially the same in these two different types of experiments is highly significant. We have speculated that the gas-phase ozonolysis of TME produces an energy-rich form of the carbonyl oxide, acetone oxide. Some of this carbonyl oxide may cyclize to the isomeric DMD which, we propose, is responsible for oxide formation in the TME/ozone experiment. This proposal is supported by the observation that using ozone alone to oxidize 1-NP does not lead to oxide formation. Thus the oxidant responsible for oxide formation in the TME/ozone experiment must be produced in the ozonolysis. We suggest that this oxidant is DMD.

Adsorption↗
PubMed2002

Assessment of soil contamination--a functional perspective.

In many industrialized countries the use of land is impeded by soil pollution from a variety of sources. Decisions on clean-up, management or set-aside of contaminated land are based on various considerations, including human health risks, but ecological arguments do not have a strong position in such assessments. This paper analyses why this should be so, and what ecotoxicology and theoretical ecology can improve on the situation. It seems that soil assessment suffers from a fundamental weakness, which relates to the absence of a commonly accepted framework that may act as a reference. Soil contamination can be assessed both from a functional perspective and a structural perspective. The relationship between structure and function in ecosystems is a fundamental question of ecology which receives a lot of attention in recent literature, however, a general concept that may guide ecotoxicological assessments has not yet arisen. On the experimental side, a good deal of progress has been made in the development and standardized use of terrestrial model ecosystems (TME). In such systems, usually consisting of intact soil columns incubated in the laboratory under conditions allowing plant growth and drainage of water, a compromise is sought between field relevance and experimental manageability. A great variety of measurements can be made on such systems, including microbiological processes and activities, but also activities of the decomposer soil fauna. I propose that these TMEs can be useful instruments in ecological soil quality assessments. In addition a "bioinformatics approach" to the analysis of data obtained in TME experiments is proposed. Soil function should be considered as a multidimensional concept and the various measurements can be considered as indicators, whose combined values define the "normal operating range" of the system. Deviations from the normal operating range indicate that the system is in a condition of stress. It is hoped that more work along this line will improve the prospects for ecological arguments in soil quality assessment.

Computational Biology↗
PubMed1995

Non-genetic propagation of strain-specific properties of scrapie prion protein.

The infectious agents causing scrapie and other transmissible spongiform encephalopathies have been postulated to consist solely of the protease-resistant form of prion protein (PrPSc). One unprecedented requirement of the protein-only model is that the 'inheritance' of pathogen strain differences must be mediated by stable variations in PrPSc structure, rather than mutations in an agent-specific nucleic acid. Strain differences in PrPSc structure have been described for the hyper (HY) and drowsy (DY) strains of hamster transmissible mink encephalopathy (TME), a scrapie-like disease originating in mink. Although HY and DY PrPSc are both post-translationally derived from the precursor prion protein (PrPC) they are cleaved at different amino-terminal sites by proteinase K (ref. 8). Here we investigate whether this strain-specific property of PrPSc is transmitted to PrPC during formation of new PrPSc. PrPSc from the HY and DY TME strains converted the protease-sensitive PrPC into two distinct sets of protease-resistant PrP products in a cell-free system. These data provide evidence that self-propagation of PrPSc polymers with distinct three-dimensional structures could be the molecular basis of scrapie strains.

Animals↗
PubMed2021

Viral infection of cells within the tumor microenvironment mediates antitumor immunotherapy via selective TBK1-IRF3 signaling.

Activating intra-tumor innate immunity might enhance tumor immune&#xa0;surveillance. Virotherapy is proposed to achieve tumor cell killing, while indirectly activating innate immunity. Here, we report that recombinant poliovirus therapy primarily mediates antitumor immunotherapy via direct infection of non-malignant tumor microenvironment (TME) cells, independent of malignant cell lysis. Relative to other innate immune agonists, virotherapy provokes selective, TBK1-IRF3 driven innate inflammation that is associated with sustained type-I/III interferon (IFN) release. Despite priming equivalent antitumor T cell quantities, MDA5-orchestrated TBK1-IRF3 signaling, but not NF&#x3ba;B-polarized TLR activation, culminates in polyfunctional and Th1-differentiated antitumor T cell phenotypes. Recombinant type-I IFN increases tumor-localized T cell function, but does not mediate durable antitumor immunotherapy without concomitant pattern recognition receptor (PRR) signaling. Thus, virus-induced MDA5-TBK1-IRF3 signaling in the TME provides PRR-contextualized IFN responses that elicit functional antitumor T cell immunity. TBK1-IRF3 innate signal transduction stimulates eventual function and differentiation of tumor-infiltrating T cells.

Animals↗
PubMed2026

A pancreatic cancer organoid-macrophage co-culture using starPEG-heparin hydrogel deciphers tumor-immune cell interactions.

Macrophages are among the most abundant immune cells in the pancreatic ductal adenocarcinoma (PDAC) tumor microenvironment (TME) and play a key role in regulating the immunosuppressive niche that facilitates tumor growth. Although recent three-dimensional (3D) culture systems using patient-derived materials have advanced our understanding of tumor biology, most models lack key cellular TME components and thus fail to capture tumor-immune cell interactions. To address this gap, we developed an in-vitro 3D co-culture model incorporating PDAC patient-derived organoids (PDOs) and macrophages within a synthetic hydrogel matrix. We optimized culture conditions by tuning medium and matrix conditions to support both cell lineages. Flow cytometry and transcriptomic analyses revealed that initially undifferentiated macrophages adopt an M2-like profile upon exposure to PDAC PDOs in starPEG-heparin hydrogels, mirroring the macrophage phenotypes observed by multiplex immunohistochemistry in the matched primary PDAC tissues. Cytokine secretome profiling revealed PDO-specific differences, indicating distinct underlying macrophage polarization subtypes. Collectively, our starPEG-heparin hydrogel-based 3D co-culture enables hypothesis-driven and physiologically relevant studies of tumor-macrophage interactions and may advance immune-modulatory treatment strategies in patients with PDAC.

Journal Article↗
PubMed2001

Tumour location and the effects of preoperative radiotherapy in the treatment of rectal cancer.

BACKGROUND: Preoperative radiotherapy improves local control and survival in rectal cancer, but may also increase postoperative morbidity and mortality rates. Establishing selection criteria for preoperative radiotherapy is crucial. The tumour level above the anus may be one such criterion. The effect of preoperative radiotherapy in relation to the distance between the tumour and the anus was therefore assessed. METHODS: In 457 patients operated for cure included in the Stockholm II Trial the local recurrence rate in irradiated and non-irradiated patients was analysed in relation to the tumour location (low, mid or upper rectum). RESULTS: Radiotherapy reduced the local recurrence rate from 30 to 20 per cent in low rectal cancer, from 25 to 11 per cent in mid rectal cancer and from 21 to 5 per cent for tumours in the upper rectum. CONCLUSION: With conventional surgical techniques preoperative radiotherapy plays an important role in rectal cancer irrespective of the location of the tumour. To irradiate only patients with tumours in the lower rectum and to omit this treatment for patients with tumours in the mid and upper rectum cannot be recommended. Whether this statement is valid with standardized total mesorectal excision (TME) surgery is not known. Until this knowledge is available the current indications for preoperative radiotherapy should probably also be used with TME surgery.

Adenocarcinoma↗
PubMed2000

Bladder and sexual dysfunction after mesorectal excision for rectal cancer.

BACKGROUND: Urinary and sexual dysfunction are recognized complications of rectal excision for cancer. The aim of this study was to examine the frequency of such complications after mesorectal excision, shortly after this method was introduced. METHODS: Spontaneous flowmetry, residual volume of urine measurement and urodynamic examination, including cystometry and simultaneous detrusor pressure and urinary flow recording, was carried out before and 3 months after curative rectal excision. Urinary symptoms and sexual function were evaluated by means of questionnaires before and after operation. Each patient served as his or her own control. RESULTS: Forty-nine consecutive patients, 39 of whom had a total mesorectal excision (TME) and ten a partial mesorectal excision, were examined before surgery and 35 again after operation. In two patients, a weak detrusor was detected before operation. Two patients developed signs of bladder denervation after operation. Transitory moderate urinary incontinence appeared in four other women. Six of 24 men reported some reduction in erectile function and one became impotent. Two men reported retrograde ejaculation. All the complications were seen in the TME group. CONCLUSION: Mesorectal excision for rectal cancer resulted in a low frequency of serious bladder and sexual dysfunction.

Adult↗
PubMed2000

Preoperative staging of rectal cancer allows selection of patients for preoperative radiotherapy.

BACKGROUND: Variability in rates of local recurrence following resection of rectal cancer has led to the suggestion that all patients should undergo preoperative radiotherapy. This centre employs a selective policy of radiotherapy only in patients with evidence of advanced local disease determined by preoperative staging. METHODS: A retrospective review was carried out of 114 consecutive patients with rectal cancer. Patients were divided before operation into palliative and curative groups based on preoperative staging. Only patients in the palliative group were offered preoperative radiotherapy. Total mesorectal excision (TME) was performed for all tumours of the middle or lower rectum. RESULTS: The perioperative mortality rate was 0.9 per cent and anastomotic dehiscence occurred in 2.8 per cent. Local recurrence developed in 4 per cent of patients in the 'curative' group and in seven of 15 of those assigned to the palliative group before operation (P < 0.01). Positive lateral resection margins were significantly associated with a risk of subsequent recurrence (ten of 13 versus three (3 per cent) of 93; P < 0.001). CONCLUSION: Preoperative adjuvant radiotherapy can be omitted reasonably in patients in whom there is no evidence of locally advanced disease, provided that adequate surgery, incorporating TME for low tumours, is performed.

Adult↗
PubMed2003

Pre-operative short-course radiotherapy is associated with faecal incontinence after anterior resection.

OBJECTIVE: To determine the contribution of total mesorectal excision (TME), short-course pre-operative radiotherapy (SCRT), the level of the anastomosis and other putative contributory factors to the incidence and degree of faecal incontinence after anterior resection of the rectum. PATIENTS AND METHODS: Survivors of anterior resection of the rectum performed between February 1996 and February 2001, with a functioning anastomosis, were asked to complete a telephone questionnaire regarding their current bowel habit. Faecal incontinence was scored using the St. Mark's Incontinence Score. RESULTS: The median age of 124 patients who completed the questionnaire was 76 years. Of these, 104 patients had neoplastic disease, 66 (53%) patients exhibited some degree of incontinence, median St. Marks' Score 6, interquartile range 3-10. There was a significant association between the anastomotic level, and the St. Mark's Score (P < 0.0001, linear regression). Male sex (P = 0.047), SCRT (P = 0.0014) and an anastomotic leak (P = 0.038) were associated with significantly higher incontinence scores. Age, splenic flexure mobilization, TME, anastomotic configuration or use of a temporary stoma had no detectable independent effect on incontinence scores. CONCLUSIONS: Poor functional outcome following anterior resection was associated with a low anastomosis, SCRT or an anastomotic leak. The finding that SCRT was a predictor of postoperative incontinence emphasizes the need for stringent patient selection for this treatment modality.

Aged↗