Neoadjuvant Chemoradiation Increases the Risk of Pelvic Sepsis After Radical Excision of Rectal Cancer

Abstract

The addition of neoadjuvant chemoradiation to mesorectal excision significantly increased the rate of pelvic sepsis. This was particularly true for anastomoses in the lower third of the rectum. Fecal diversion should be considered in these patients.

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

“…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. In contrast, anastomotic leaks occurred twice as frequently in patients receiving neoadjuvant therapy compared to patients undergoing TME surgery alone in the study by Buie et al [22]. Moreover, preoperative RCT was identified as the sole idependent predictive risk factor for anastomotic leakage or pelvic abscess in this trial.…”

“…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.…”

Neoadjuvant Therapy and Anastomotic Leak After Tumor-Specific Mesorectal Excision for Rectal Cancer

“…[22][23][24][25][26] Despite our findings, there remains controversy in the literature as to whether neoadjuvant short-term radiation and long-course CXRT increase the incidence of anastomotic dehiscence. Several studies in the literature have demonstrated an increased incidence of anastomotic leakage after both short-term and long-term CXRT as high as 12 percent in some series, [27][28][29] whereas others have demonstrated equivalence. 4,17,30,31 As a result, it is not surprising that practice patterns among surgeons vary considerably as was demonstrated in the present study, with some surgeons routinely performing diverting ileostomy in all patients who received neoadjuvant CXRT.…”

Postoperative Morbidity Following Chemoradiation for Locally Advanced Low Rectal Cancer

“…[17][18][19][20][21][22][23][24] Furthermore, it is assumed that postoperative complications are associated with a significant increase in loco-regional recurrence and worse long-term survival rates. [17][18][19] The risks of any wound complications, either major perineal or pelvic sepsis, are reported to be doubled 25,26 in patients with preoperative chemoradiation. These infectious complications could be due to a significant reduction on collagen accumulation and an impaired leukocyte production.…”