Analysis of Early Postoperative Morbidity Among Patients with Rectal Cancer Treated with and without Neoadjuvant Chemoradiotherapy

Abstract

Background: The impact of neoadjuvant treatment and their subsequent early complications in the treatment of rectal cancer has not been adequately assessed. The aim of this prospective study was to evaluate early postoperative morbidity and mortality among patients with rectal cancer treated with adjuvant radiotherapy and chemotherapy followed by surgery, compared with patients treated with surgery alone. We also identified independent risk factors associated with early major complications. Methods: Between 1995 and 2004, 273 consecutive patients underwent treatment for rectal cancer. A total of 170 patients (group A) received preoperative radiotherapy with a total of 45-50.4 Gy (180 cGy per day) and 5-fluorouracil-based chemotherapy, followed by surgery; 103 patients (group B) were treated with surgery alone. Dependent variables related to patients, treatment, radiotherapy, and tumor were analyzed. Results: Both groups were similar with regard to age, sex, body mass index, American Society of Anesthesiologists (ASA) score, and tumor location but not for ileostomy (27% in group A vs. 6.8% in group B). The number of complications was similar in both groups (43.1% in group A vs. 44.6% in group B). No differences in wound infection (8.2% vs. 7.8%), intraabdominal abscess (4.7% vs. 4.9%), anastomotic dehiscence (4.2% vs. 3.8%), postoperative hemorrhage (3.5% vs. 3.9%), urinary complications (6.5% vs. 4.9%), paralytic ileus (8.9% vs. 9.7%), or general complications (7.1% vs. 9.6%) were found. The global mortality in the first 30 days after surgery was .7%. An ASA score of III-IV and surgery duration longer than 3 hours were identified as independent prognostic factors for early complications. Conclusions: Preoperative chemoradiation in patients with rectal cancer treated with surgery is not associated with a higher incidence of early postoperative complications. The patient~s preoperative clinical condition and lengthy surgery time are prognostic factors for early complications.

Morbidity Risk Factors After Low Anterior Resection With Total Mesorectal Excision and Coloanal Anastomosis

“…A number of studies have examined clinical factors associated with anastomotic leakage after rectal surgery. In a study by Valenti et al, 41 blood transfusion during surgery for rectal cancer including LAR, Hartman procedure and abdominoperineal resection was associated in univariate analysis with anastomotic leakage and intra-abdominal abscess. In several studies male sex is predictive of anastomotic leakage after anterior resection.…”

Neoadjuvant chemoradiotherapy for rectal carcinoma: effects on anastomotic leak rate and postoperative bladder dysfunction after non-emergency sphincter-preserving anterior rectal resection

“…Similar results were reported by Rosati et al [19] who retrospectively compared 20 patients receiving RCT before TME surgery with 39 individuals undergoing TME alone. Several risk factors for postoperative anastomotic leakage were identified by Valenti et al [21] and Martel et al [25] in their studies of 273 (170 receiving preoperative RCT) and 220 (54 receiving preoperative RCT) patients, respectively. These included comorbidity, extended operating time, low anastomosis, tobacco smoking, and technically "difficult" anastomosis; however, preoperative RCT was not associated with an elevated risk for anastomotic leakage.…”

“…However, this was predominantly due to an elevated number of perineal wound complications after abdomino-perineal excision while preoperative radiation had no influence on the anastomotic leak rate after anterior resection [16]. Apart from these two multicenter RCTs, most studies dealing with the influence of preoperative therapy on anastomotic leak rate after rectal cancer surgery have been single-center trials including relatively few patients (n=39 through 425) [17][18][19][20][21][22][23][24][25][26][27][28]. Preoperative RT or CRT was not related to anastomotic leak rate in some of these trials while it was an independent risk factor for anastomotic leakage in others.…”

Total pelvic exenteration for rectal cancer: outcomes and prognostic factors

“…Although highly efficacious, [15][16][17] it is controversial whether the increased use of neoadjuvant chemoradiation therapy in locally advanced operable rectal carcinoma contributes significantly to postoperative mor bid ity. 18,19 In the face of disparate data regarding the morbidity associated with this procedure, we wanted to provide detailed analysis of morbidity and survival of patients with rectal carcinoma who underwent TPE. We sought to identify disease-and patient-specific factors that might indicate what patients would receive maximal benefit from such aggressive treatment.…”