Annals of Surgical Oncology

, Volume 21, Issue 7, pp 2295–2302 | Cite as

Neoadjuvant Radiation Therapy Prior to Total Mesorectal Excision for Rectal Cancer is Not Associated with Postoperative Complications Using Current Techniques

  • Sarah A. Milgrom
  • Karyn A. Goodman
  • Garrett M. Nash
  • Philip B. Paty
  • José G. Guillem
  • Larissa K. Temple
  • Martin R. Weiser
  • Julio Garcia-AguilarEmail author
Colorectal Cancer



Neoadjuvant radiation therapy (RT) downstages rectal cancer but may increase postoperative morbidity. This study aims to quantify 30-day complication rates after total mesorectal excision (TME) using current techniques and to assess for an association of these complications with neoadjuvant RT.


Stage I–III rectal cancer patients who underwent TME from 2005 to 2010 were identified. Complications occurring within 30 days after TME were retrieved from a prospectively maintained institutional database of postoperative adverse events.


The cohort consisted of 461 patients. Median age was 59 years (range 18–90), and 274 patients (59 %) were male. Comorbid conditions included obesity (n = 147; 32 %), coronary artery disease (n = 83; 18 %), diabetes (n = 65; 14 %), and inflammatory bowel disease (n = 19; 4 %). A low anterior resection (LAR) was performed in 383 cases (83 %), an abdominoperineal resection (APR) was performed in 72 cases (16 %), and a Hartmann’s procedure was performed in 6 cases (1 %). Preoperative RT was delivered to 310 patients (67 %; median dose of 50.4 Gy, range 27–55.8 Gy). The 30-day incidence of postoperative mortality was 0.4 % (n = 2), any complication 25 % (n = 117), grade 3 or more complication 5 % (n = 24), intra-abdominal infection 3 % (n = 12), abdominal wound complication 9 % (n = 42), perineal wound complication after APR 11 % (n = 8/72), and anastomotic leak after LAR 2 % (n = 6/383). These events were not associated with neoadjuvant RT.


In a cohort undergoing TME using current techniques, neoadjuvant RT was not associated with 30-day postoperative morbidity or mortality.


Rectal Cancer Total Mesorectal Excision Preoperative Radiation Therapy Rectus Abdominis Myocutaneous Surgical Care Improvement Project 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflicts of Interest


Financial Support

This study was funded in part by the Cancer Center core grant P30 CA008748. The core grant provides funding to institutional cores, such as biostatistics and pathology, which were used in this study.


  1. 1.
    Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–1740.PubMedCrossRefGoogle Scholar
  2. 2.
    El-Gazzaz G, Kiran RP, Lavery I. Wound complications in rectal cancer patients undergoing primary closure of the perineal wound after abdominoperineal resection. Dis Colon Rectum. 2009;52:1962–1966.PubMedCrossRefGoogle Scholar
  3. 3.
    Christian CK, Kwaan MR, Betensky RA, et al. Risk factors for perineal wound complications following abdominoperineal resection. Dis Colon Rectum. 2005;48:43–48.PubMedCrossRefGoogle Scholar
  4. 4.
    Nissan A, Guillem JG, Paty PB, et al. Abdominoperineal resection for rectal cancer at a specialty center. Dis Colon Rectum. 2001;44:27-35.PubMedCrossRefGoogle Scholar
  5. 5.
    Enker WE, Merchant N, Cohen AM, et al. Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg. 1999;230:544–552.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Luna-Perez P, Rodriguez-Ramirez S, Vega J, et al. Morbidity and mortality following abdominoperineal resection for low rectal adenocarcinoma. Rev Invest Clin. 2001;53:388–395.PubMedGoogle Scholar
  7. 7.
    Bullard KM, Trudel JL, Baxter NN, Rothenberger DA. Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure. Dis Colon Rectum. 2005;48:438–443.PubMedCrossRefGoogle Scholar
  8. 8.
    Lee WS, Yun SH, Roh YN, et al. Risk factors and clinical outcome for anastomotic leakage after total mesorectal excision for rectal cancer. World J Surg. 2008;32:1124–1129.PubMedCrossRefGoogle Scholar
  9. 9.
    Zorcolo L, Restivo A, Capra F, et al. Does long-course radiotherapy influence postoperative perineal morbidity after abdominoperineal resection of the rectum for cancer? Colorectal Dis. 2011;13:1407–1412.PubMedCrossRefGoogle Scholar
  10. 10.
    Cima R, Dankbar E, Lovely J, et al. Colorectal surgery surgical site infection reduction program: a national surgical quality improvement program–driven multidisciplinary single-institution experience. J Am Coll Surg. 2013;216:23–33.PubMedCrossRefGoogle Scholar
  11. 11.
    O’Connell MJ, Martenson JA, Wieand HS, et al. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med. 1994;331:502–507.PubMedCrossRefGoogle Scholar
  12. 12.
    Ramani VS, Sun Myint A, Montazeri A, Wong H. Preoperative chemoradiotherapy for rectal cancer: a comparison between intravenous 5-fluorouracil and oral capecitabine. Colorectal Dis. 2010;12 Suppl 2:37–46.PubMedCrossRefGoogle Scholar
  13. 13.
    Schrag D. Neoadjuvant FOLFOX-bev, without radiation, for locally advanced rectal cancer. J Clin Oncol. 2010;28:3511.Google Scholar
  14. 14.
    Myerson RJ, Garofalo MC, El Naqa I, et al. Elective clinical target volumes for conformal therapy in anorectal cancer: a Radiation Therapy Oncology Group consensus panel contouring atlas. Int J Radiat Oncol Biol Phys. 2009;74:824–830.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Horan TC, Gaynes RP, Martone WJ, et al. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13:606–608.PubMedCrossRefGoogle Scholar
  16. 16.
    Matthiessen P, Hallbook O, Andersson M, et al. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. 2004;6:462–469.PubMedCrossRefGoogle Scholar
  17. 17.
    Armstrong M. Obesity as an intrinsic factor affecting wound healing. J Wound Care. 1998;7:220–221.PubMedGoogle Scholar
  18. 18.
    Kerr SF, Norton S, Glynne-Jones R. Delaying surgery after neoadjuvant chemoradiotherapy for rectal cancer may reduce postoperative morbidity without compromising prognosis. Br J Surg. 2008;95:1534–1540.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Sarah A. Milgrom
    • 1
  • Karyn A. Goodman
    • 2
  • Garrett M. Nash
    • 1
  • Philip B. Paty
    • 1
  • José G. Guillem
    • 1
  • Larissa K. Temple
    • 1
  • Martin R. Weiser
    • 1
  • Julio Garcia-Aguilar
    • 1
    Email author
  1. 1.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Radiation OncologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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