Preoperative 'Chemoradiation' for Stages II and III Rectal Carcinoma

Stryker, Steven J.; Kiel, Krystyna; Rademaker, Alfred; Shaw, John M.; Ujiki, Gerald T.; Poticha, Stuart M.

doi:10.1001/archsurg.1996.01430170060012

Cited by 70 publications

(27 citation statements)

References 16 publications

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“…In our own experience, and in agreement with other published studies, 14,15,[31][32][33] we consider that preoperative chemoradiotherapy does not increase either the number of early postoperative complications or the rate of surgical mortality. We should be cautious with these results because ours is not a randomized, double-blind study.…”

Section: Discussionsupporting

confidence: 92%

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

et al. 2007

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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.

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Section: Discussionsupporting

confidence: 92%

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

et al. 2007

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“…Mean tumor distance from the anal verge was 6 cm (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Of those staged before surgery with endorectal ultrasound or magnetic resonance imaging, 57% of stage II patients and 82% of stage III patients were downstaged.…”

Section: Resultsmentioning

confidence: 99%

“…1,11-13 Addition of 5-fluorouracilbased chemotherapy to radiotherapy to radiosensitize the Neoadjuvant Therapy for Rectal Cancer primary tumor and to eliminate systemic micrometastases has also improved rates of both recurrence-free 10,14 -17 and overall survival 10,[15][16][17][18] (Table 3). Considering our chemotherapeutic regimens, the use of 5-fluorouracil along with cisplatin conferred no advantage in local recurrence rates or survival and may have contributed to a higher complication rate compared with the use of 5-fluorouracil alone.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant Chemoradiation for Rectal Cancer: Analysis of Clinical Outcomes From a 13-Year Institutional Experience

Onaitis¹,

Noone²,

Hartwig³

et al. 2001

Annals of Surgery

138

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ObjectiveTo examine clinical outcomes in patients receiving neoadjuvant chemoradiation for locally advanced rectal adenocarcinoma. Summary Background DataPreoperative radiation therapy, either alone or in combination with 5-fluorouracil-based chemotherapy, has proven both safe and effective in the treatment of rectal cancer. However, data are lacking regarding which subgroups of patients benefit from the therapy in terms of decreased local recurrence and increased survival rates. MethodsA retrospective chart review was performed on 141 consecutive patients who received neoadjuvant chemoradiation (5-fluorouracil Ϯ cisplatin and 4,500 -5,040 cGy) for biopsyproven locally advanced adenocarcinoma of the rectum. Surgery was performed 4 to 8 weeks after completion of chemoradiation. Standard statistical methods were used to analyze recurrence and survival. ResultsMedian follow-up was 27 months, and mean age was 59 years (range 28 -81). Mean tumor distance from the anal verge was 6 cm (range 1-15). Of those staged before surgery with endorectal ultrasound or magnetic resonance imaging, 57% of stage II patients and 82% of stage III patients were downstaged. The chemotherapeutic regimens were well tolerated, and resections were performed on 140 patients. The percentage of sphincter-sparing procedures increased from 20% before 1996 to 76% after 1996. On pathologic analysis, 24% of specimens were T0. However, postoperative pathologic T stage had no effect on either recurrence or survival. Positive lymph node status predicted increased local recurrence and decreased survival. ConclusionsNeoadjuvant chemoradiation is safe, effective, and well tolerated. Postoperative lymph node status is the only independent predictor of recurrence and survival.

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“…However, evidence for this is derived only from scientific experiments [29,30]. According to our experience and that of other studies [31][32][33][34][35], the morbidity rates are not increased in patients treated with neoadjuvant therapy (group A), compared to those patients treated with surgery alone (group B) (22.9% vs 26.4%). When applying POSSUM to the groups created with this variable, we observed an overprediction of morbidity rates in patients receiving neoadjuvant therapy (group A) (22.9% vs 32.05%) and an accurate prediction in patients treated with surgery alone (group B) (32% vs 29.1%).…”

Section: Discussionmentioning

confidence: 68%

Analysis of POSSUM score and postoperative morbidity in patients with rectal cancer undergoing surgery

Valentí

Hernández-Lizoain

Baixauli

et al. 2008

Langenbecks Arch Surg

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Background The Physiological and Operative Severity Score for the enUmeration of Mortality andmorbidity (POSSUM) and later modifications (P-POSSUM y CRPOSSUM) have been used to predictmorbidity and mortality rates among patients with rectal cancer undergoing surgery. These calculations needsome adjustment, however. The aim of this study was to assess the applicability of POSSUM to a group ofpatients with rectal cancer undergoing surgery, analysing surgical morbidity by means of several variables. Methods between January 1995 and December 2004, 273 consecutive patients underwent surgery forrectal cancer. Information was gathered about the patients, tumour and therapy. To assess the predictioncapacity of POSSUM, subgroups for analysis were created according to variables related to operativemorbidity and mortality. Results The global morbidity rate was 23.6% (31.2% predicted by POSSUM). The mortality rate was 0.7% (6.64, 1.95 and 2.08 predicted by POSSUM, P-POSSUM and CR-POSSUM respectively). POSSUMpredictions may be more accurate for patients younger than 51 years, older than 70 years, with low anaesthetic risk (ASA I/II), DUKES stage C and D, surgery duration of less than 180 minutes and for thosereceiving neoadjuvant therapy. Conclusion POSSUM is a good instrument to make results between different institutions and publicationcomparable. We found prediction errors for some variables related to morbidity. Modifications of surgicalvariables and specifications for neoadjuvant therapy as well as physiological variables including life stylemay improve future prediction of surgical risk. More research is needed to identify further potential riskfactors for surgical complications.

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Preoperative 'Chemoradiation' for Stages II and III Rectal Carcinoma

Cited by 70 publications

References 16 publications

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

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

Neoadjuvant Chemoradiation for Rectal Cancer: Analysis of Clinical Outcomes From a 13-Year Institutional Experience

Analysis of POSSUM score and postoperative morbidity in patients with rectal cancer undergoing surgery

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