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

Garlipp, Benjamin; Ptok, H.; Schmidt, Uwe; Meyer, Frank; Gastinger, I.; Lippert, H.

doi:10.1007/s00423-010-0708-0

Cited by 36 publications

(34 citation statements)

References 39 publications

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“…We postulated that radiation might have adverse effects on the autonomic nerves and consequently result in bladder dysfunction. However, Garlipp et al [26] demonstrated that preoperative CRT was not a risk factor for bladder dysfunction after undergoing a sphincter preserving rectal resection. The relationship between preoperative CRT and bladder dysfunction has not been established.…”

Section: Discussionmentioning

confidence: 99%

Short-term outcomes after laparoscopic surgery following preoperative chemoradiotherapy for rectal cancer

et al. 2012

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PurposeThe safety and the feasibility of performing laparoscopic surgery for rectal cancer after preoperative chemoradiotherapy (CRT) have not yet been established. Thus, the aim of this study was to evaluate the efficacy and the safety of laparoscopic rectal cancer surgery performed after preoperative CRT.MethodsWe enrolled 124 consecutive patients who underwent laparoscopic surgery for rectal cancer. Of these patients, 56 received preoperative CRT (CRT group), whereas 68 did not (non-CRT group). The patients who were found to have distant metastasis and open conversion during surgery were excluded. The clinicopathologic parameters were evaluated and the short-term outcomes were compared between the CRT and non-CRT groups.ResultsThe mean operation time was longer in the CRT group (294 minutes; range, 140 to 485 minutes; P = 0.004). In the non-CRT group, the tumor sizes were larger (mean, 4.0 cm; range, 1.2 to 8.0 cm; P < 0.001) and more lymph nodes were harvested (mean, 12.9; range, 0 to 35; P < 0.001). However, there was no significant difference between the two groups in time to first bowel movement, tolerance of a soft diet, length of hospital stay, and postoperative complication rate.ConclusionPerforming laparoscopic surgery for rectal cancer after preoperative CRT may be safe and feasible if performed by a highly skilled laparoscopic surgeon. Randomized controlled trials and long-term follow-up studies are necessary to support our results.

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Section: Discussionmentioning

confidence: 99%

Short-term outcomes after laparoscopic surgery following preoperative chemoradiotherapy for rectal cancer

et al. 2012

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“…A smaller subset has also looked into the potential implications on long-term bladder as well as sexual function; however, the issue also becomes more difficult to analyze due to the need for intraoperative preservation of the autonomic nerve plexuses [64]. Despite the large number of randomized trials that have investigated the role of various regimens of neoadjuvant therapy, few have done so with a standardized TME dissection protocol for participating surgeons.…”

Section: Surgery-related Outcomes Following Neoadjuvant Therapy: Funcmentioning

confidence: 99%

Surgeon perspectives on the use and effects of neoadjuvant chemoradiation in the treatment of rectal cancer: a comprehensive review of the literature

Chadi

Berho

Wexner

2015

Langenbecks Arch Surg

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The initial benefit of adjuvant therapy in the treatment of rectal cancer patients became evident with prospective studies demonstrating improvements in various oncologic survival outcomes. Due to the improved compliance and reduced toxicity, as well as the potential for tumor down-staging and sphincter preservation, neoadjuvant approaches became the preferred method of administering chemotherapy and radiation. Furthermore, a subgroup of patients has been shown to present with complete clinical response to neoadjuvant therapy. This has resulted in the development of the non-operative "watch and wait" approach, which has initiated discussions on changing the interval from the completion of neoadjuvant therapy to surgical resection. The continued development of the multidisciplinary approach will only further improve our ability to provide patients with the best possible oncologic outcomes.

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“…Therefore, these locations of GI anastomoses are the most studied. Although some have reported no increase in anastomotic leak in colorectal surgery following chemoradiation therapy, 51 others have demonstrated that there is evidence that preoperative chemotherapy increases the risk of anastomotic leak in colorectal surgery. 1,52 At the same time, neoadjuvant chemotherapy has not been shown to increase anastomotic leak rate in esophageal surgery.…”

Section: Steroids/immune Modulatorsmentioning

confidence: 99%

Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions

Phillips¹

2016

OAS

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Various techniques and interventions have been developed in an effort to obviate gastrointestinal anastomotic leaks. This review is intended to delineate potential modifications that can be made to reduce the risk of anastomotic leaks following gastrointestinal surgery. It may also serve to aid in identifying patients who are at increased risk of anastomotic leak. Modifiable risk factors for leak discussed include malnutrition, smoking, steroid use, bowel preparation, chemotherapy, duration of surgery, use of pressors, intravenous fluid administration, blood transfusion, and surgical anastomotic technique. Based upon literature review, operative techniques should include minimizing operative time, reducing ischemia, and utilizing stapled anastomoses. Buttressing of anastomoses with omentum has proven utility for esophageal surgery. Further recommendations include 5-7 days of immune-modifying nutritional supplementation for malnourished patients, discontinuation of smoking in the perioperative period, limiting steroid use, utilization of oral antibiotic preparation for colorectal surgery, avoidance of early operations (,4 weeks) following chemotherapy, limiting pressor use, and the utilization of goal-directed fluid management.

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

Abstract: Neoadjuvant chemoradiotherapy for rectal carcinoma does not increase the risk for anastomotic leakage or postoperative bladder dysfunction after curatively intended sphincter-preserving rectal resection.

Cited by 36 publications

References 39 publications

Short-term outcomes after laparoscopic surgery following preoperative chemoradiotherapy for rectal cancer

Short-term outcomes after laparoscopic surgery following preoperative chemoradiotherapy for rectal cancer

Surgeon perspectives on the use and effects of neoadjuvant chemoradiation in the treatment of rectal cancer: a comprehensive review of the literature

Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions

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