Skip to main content

Advertisement

SpringerLink
Log in

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

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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%), intra-abdominal 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Heald RJ, Husband EM, Ryall RDH. The mesorectum in rectal cancer surgery. The clue to pelvic recurrence? Br J Surg 1982; 69:613–6

    Article  PubMed  CAS  Google Scholar 

  2. Heald RJ, Moran BJ, Brown G, Daniels IR. Optimal total mesorectal excision for rectal cancer is by dissection in front of Denonvilliers’ fascia. Br J Surg 2004; 91:121–3

    Article  PubMed  CAS  Google Scholar 

  3. Kapiteijn E, Marijnen C, Nagtegaa ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001; 345:638–46

    Article  PubMed  CAS  Google Scholar 

  4. Camma C, Giunta M, Fiorica F, Pagliario L, Craxi A, Cottone M. Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. JAMA 2000; 284:1008–15

    Article  PubMed  CAS  Google Scholar 

  5. Lee J, Lee L, Ahn J, et al. Randomized trial of postoperative adjuvant therapy in stage II and III rectal cancer to define the optimal sequence of chemotherapy and radiotherapy. J Clin Oncol 2002; 20:1751–8

    Article  PubMed  CAS  Google Scholar 

  6. Minsky BD, Cohen A, Kenemy N, et al. Combined modality therapy of rectal cancer: decreased acute toxicity with the preoperative approach. J Clin Oncol 1992; 10:1218–24

    PubMed  CAS  Google Scholar 

  7. Wagman R, Minsky BD, Cohen A, et al. Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: long term follow-up. Int J Oncol Biol Phys 1998; 42:51–7

    Article  CAS  Google Scholar 

  8. Rouanet P, Fabre J, Dubois J, et al. Conservative surgery for low rectal carcinoma after high-dose radiation. Functional and oncologic results. Ann Surg 1995; 221:67–73

    Article  PubMed  CAS  Google Scholar 

  9. Sauer R, Becker H, Hohenberger E, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004; 351:1731–40

    Article  PubMed  CAS  Google Scholar 

  10. Santiago R, Metz JM, Hanh S. Chemoradiotherapy in the treatment of rectal cancer. Hematol Oncol Clin N Am 2002; 16:995–1014

    Article  Google Scholar 

  11. Ruo L, Tickoo S, Klimstra DS, et al. Long-term prognostic significance of extent of rectal cancer response to preoperative radiation and chemotherapy. Ann Surg 2002; 236:75–81

    Article  PubMed  Google Scholar 

  12. Kuzu MA, Koksoy C, Akyol F, Uzal D, Kale T. Effects of preoperative fractionated irradiation on left colonic anastomoses in the rat. Dis Colon Rectum 1998; 41:370–6

    Article  PubMed  CAS  Google Scholar 

  13. Dominuez J, Jakate S, Speziale S, Savin M, Altringer WE, Saclarides TJ. Intestinal anastomotic healing at varying times after irradiation. J Surg Res 1996; 61:293–9

    Article  Google Scholar 

  14. Pucciarelli S, Toppan P, Friso M, et al. Preoperative combined radiotherapy and chemotherapy for rectal cancer does not affect early postoperative morbidity and mortality in low anterior resection. Dis Colon Rectum 1999; 42:1276–84

    Article  PubMed  CAS  Google Scholar 

  15. Marijnen C, Kapiteijn E, Van de Velde C, et al. Acute effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 2002; 20:817–25

    Article  PubMed  CAS  Google Scholar 

  16. Holm T, Rutqvist LE, Johansson H, Cedermark B. Postoperative mortality in rectal cancer treated with or without preoperative radiotherapy: causes and risk factors. Br J Surg 1996; 83:964–8

    Article  PubMed  CAS  Google Scholar 

  17. Stockholm Rectal Cancer Study Group. Preoperative short-term radiation therapy in operable rectal carcinoma: a prospective randomised trial. Cancer 1990; 66:49–55

    Article  Google Scholar 

  18. Goldberg P, Nicholls R, Porter N, Love S, Grimsey JE. Long-term results of a randomised trial of short-course low-dose adjuvant pre-operative radiotherapy or rectal cancer: reduction in local treatment failure. Eur J Cancer 1994; 30:1602–6

    Article  Google Scholar 

  19. Krook JE, Moertel CG, Gunderson LL, et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 1991; 324:709–15

    Article  PubMed  CAS  Google Scholar 

  20. Gastrointestinal Tumor Study Group. Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med 1985; 312:1465–72

    Article  Google Scholar 

  21. Kollmorgen C, Meagher A, Wolf B, et al. The long-term detrimental effect of postoperative radiation therapy for rectal carcinoma on bowel function. Proc Am Soc Colon Rectal Surg 1994; 37:7

    Google Scholar 

  22. Paty PB, Enker WE, Cohne AM, et al. Long-term functional results of coloanal anastomosis for rectal cancer. Am J Surg 1994; 167:90–5

    Article  PubMed  CAS  Google Scholar 

  23. American Society of Anesthesiologists. New classification of physical status. Anesthesiology 1963; 24:111

    Google Scholar 

  24. American Joint Committee on Cancer (AJCC). Cancer Staging Handbook: TNM Classification of Malignant Tumors. 6th ed. New York: Springer, 2002

    Google Scholar 

  25. International Commission on Radiation Units and Measurements Report 50. Prescribing, recording, and reporting photon beam therapy. International Commission on Radiation Units. Bethesda, Maryland 1993

  26. Stockholm Colorectal Cancer Study Group. Randomized study on preoperative radiotherapy in rectal carcinoma. Ann Surg Oncol 1996; 3:423–30

    Article  Google Scholar 

  27. Pahlman L, Glimelius B. Pre or postoperative radiotherapy in rectal and rectosigmoid carcinoma. Ann Surg 1990; 211:187–95

    Article  PubMed  CAS  Google Scholar 

  28. Frykholm G, Glimelius B, Pahlman L. Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and evaluation of late secondary effects. Dis Colon Rectum 1993; 36:564–72

    Article  PubMed  CAS  Google Scholar 

  29. Herzog U, Von Flue M, Tondelli P, Schuppisser JP. How accurate is endorectal ultrasound in the preoperative staging of rectal cancer? Dis Colon Rectum 1993; 36:127–34

    Article  PubMed  CAS  Google Scholar 

  30. Thomas PR, Lindblad AS, Stablein DM, Knowlton AH, Bruckner HW, Childs DS, Mittelman A. Toxicity associated with adjuvant postoperative therapy for adenocarcinoma of the rectum. Cancer 1986; 57(6):1130–1134

    Article  PubMed  CAS  Google Scholar 

  31. Hyams DM, Mamounas EP, Petrelli N, et al. A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum. A progress report of National Surgical Adjuvant Breast and Bowel Project Protocol R.03. Dis Col Rectum 1997; 40:131–9

    Article  CAS  Google Scholar 

  32. Shumate C, Rich T, Skibber J, Ajani J, Ota D. Preoperative chemotherapy and radiation therapy for locally advanced primary and recurrent rectal carcinoma. A report of surgical morbidity. Cancer 1993; 71:3690–6

    Article  PubMed  CAS  Google Scholar 

  33. Stryker SJ, Kiel KD, Rademaker A, Shaw J, Ujiki G, Poticha S. Preoperative “chemoradiation” for stages II and III rectal cancer. Arch Surg 1996; 131:514–8

    PubMed  CAS  Google Scholar 

  34. Medical Research Council Rectal Cancer Working Party. Randomised trial of surgery alone versus surgery followed by radiotherapy for mobile cancer of the rectum. Lancet 1996; 348:1610–4

    Article  Google Scholar 

  35. Swedish Rectal Cancer Trial. Initial report from Swedish multicentre study examining the role of preoperative irradiation in the treatment of patients with resectable rectal carcinoma. Br J Surg 1993; 80:1333–6

    Article  Google Scholar 

  36. Enker WE, Merchant N, Cohen A, et al. Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg 1999; 230:544–54

    Article  PubMed  CAS  Google Scholar 

  37. Bokey EL, Chapuis PH, Fung C, et al. Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum 1995; 38:480–7

    Article  PubMed  CAS  Google Scholar 

  38. Pollard C, Nivatvongs S, Rojanasakul A, Illstrup D. Carcinoma of the rectum. Profiles of intraoperative and early postoperative complications. Dis Colon Rectum 1994; 37:866–74

    Article  PubMed  CAS  Google Scholar 

  39. Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of rectal cancer. J Am Coll Surg 1995; 181:335–46

    PubMed  CAS  Google Scholar 

  40. Vignali A, Fazio VW, Lavery IC, et al. Leaks in stapled rectal anastomoses: a review of 1014 patients. J Am Coll Surg 1997; 185:105–13

    PubMed  Google Scholar 

  41. Peeters KCM, Tollenaar RAEM, Marijnen CAM, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 2005; 92:211–6

    Article  PubMed  CAS  Google Scholar 

  42. Read TE, Ogunbiyi OA, Fleshman JW, et al. Neoadjuvant external beam radiation and proctectomy for adenocarcinoma of the rectum. Dis Colon Rectum 2001; 44:1778–90

    Article  PubMed  CAS  Google Scholar 

  43. Kapiteijn E, Klein Kranenbarg E, Steup W, et al. Total mesorectal excision (TME) with or without preoperative radiotherapy in the treatment of primary rectal cancer. Eur J Surg 1999; 165:410–20

    Article  PubMed  CAS  Google Scholar 

  44. Heald RJ, Moran BJ, Ryall RDH, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 1998; 133:894–9

    Article  PubMed  Google Scholar 

  45. Wheeler JMD, Dodds E, Warren BF, et al. preoperative chemoradiotherapy and total mesorectal excision surgery for locally advanced rectal cancer: correlation with rectal cancer regression grade. Dis Colon Rectum 2004; 47:2025–31

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Clinica Universitaria de Navarra, University of Navarra, Avda. Pio XII, 36, 31080, Pamplona, Spain

    Victor Valenti, Jose Luis Hernandez-Lizoain, Jorge Baixauli, Carlos Pastor & Javier A. Alvarez-Cienfuegos

  2. Department of Radiotherapy, Clinica Universitaria de Navarra, University of Navarra, Avda. Pio XII, 36, 31080, Pamplona, Spain

    Javier Aristu & J. Diaz-Gonzalez

  3. Department of Internal Medicine, Clínica Universitaria de Navarra, University of Navarra, Avda. Pio XII, 36, 31080, Pamplona, Spain

    Juan Jose Beunza

Authors
  1. Victor Valenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jose Luis Hernandez-Lizoain
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jorge Baixauli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carlos Pastor
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Javier Aristu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Diaz-Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Juan Jose Beunza
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Javier A. Alvarez-Cienfuegos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Victor Valenti.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Valenti, V., Hernandez-Lizoain, J.L., Baixauli, J. et al. Analysis of Early Postoperative Morbidity Among Patients with Rectal Cancer Treated with and without Neoadjuvant Chemoradiotherapy. Ann Surg Oncol 14, 1744–1751 (2007). https://doi.org/10.1245/s10434-006-9338-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-006-9338-8

Keywords

Search

Navigation