Skip to main content
SpringerLink
Log in

Impact of Pelvic Radiotherapy on Morbidity and Durability of Sphincter Preservation After Coloanal Anastomosis for Rectal Cancers

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

This study was designed to assess the impact of pelvic radiotherapy on the incidence of complications and colostomy-free survival of patients after a coloanal anastomosis for rectal cancer.

Methods

A total of 192 patients underwent a coloanal anastomosis between 1982 and 2001: 87 patients did not receive pelvic radiotherapy; 105 patients received pelvic radiotherapy (39 preoperative and 66 postoperative). Early and late complications requiring surgical intervention and the colostomy-free survival rate were assessed by retrospective review of patient records.

Results

After a median follow-up of 62 months, 151 patients were alive. The most frequent complication was development of an anastomotic stricture (5-year rate of a stricture, 16 percent; 95 percent confidence interval, 10–21). Patients receiving pelvic radiotherapy had a higher rate of complications other than anastomotic strictures, including fecal incontinence, fistulas, abscesses, and bowel obstructions compared with patients not receiving pelvic radiotherapy (5-year rate: 20 percent (95 percent confidence interval, 10–29) vs. 5 percent (95 percent confidence interval, 0–10); P = 0.001). Patients receiving pelvic radiotherapy had a lower colostomy-free survival than did patients not receiving pelvic radiotherapy (5-year colostomy-free rate: 72 percent (95 percent confidence interval, 62–84) vs. 92 percent (95 percent confidence interval, 86–98); P < 0.001). There was no significant difference in the colostomy-free survival of patients receiving preoperative and postoperative pelvic radiotherapy.

Conclusions

After coloanal anastomosis, a significant number of patients will have complications requiring surgical intervention, and some will require a permanent colostomy. Pelvic radiotherapy, whether it is administered preoperatively or postoperatively, significantly increases the need for a permanent colostomy.

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

Figure 1

Similar content being viewed by others

References

  1. Ota DM, Jacobs L, Kuvshinoff B. Rectal cancer: the sphincter-sparing approach. Surg Clin North Am 2002;82:983–93.

    Article  PubMed  Google Scholar 

  2. Fazio VW, Heriot AG. Proctectomy with coloanal anastomosis. Surg Oncol Clin North Am 2005;14:157–81.

    Article  Google Scholar 

  3. Tytherleigh MG, Mortensen NJ. Options for sphincter preservation in surgery for low rectal cancer. Br J Surg 2003;90:922–33.

    Article  PubMed  CAS  Google Scholar 

  4. Guillem JG. Ultra-low anterior resection and coloanal pouch reconstruction for carcinoma of the distal rectum. World J Surg 1997;21:721–7.

    Article  PubMed  CAS  Google Scholar 

  5. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet 2001;358:1291–304.

  6. Camma C, Giunta M, Fiorica F, et al. Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. JAMA 2000;284:1008–15.

    Article  PubMed  CAS  Google Scholar 

  7. Paty PB, Enker WE, Cohen 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 

  8. Minsky BD. Sphincter preservation in rectal cancer. Preoperative radiation therapy followed by low anterior resection with coloanal anastomosis. Semin Radiat Oncol 1998;8:30–5.

    Article  PubMed  CAS  Google Scholar 

  9. Allal AS, Bieri S, Pelloni A, et al. Sphincter-sparing surgery after preoperative radiotherapy for low rectal cancers: feasibility, oncologic results and quality of life outcomes. Br J Cancer 2000;82:1131–7.

    Article  PubMed  CAS  Google Scholar 

  10. Kim NK, Lim DJ, Yun SH, et al. Ultralow anterior resection and coloanal anastomosis for distal rectal cancer: functional and oncological results. Int J Colorectal Dis 2001;16:234–7.

    Article  PubMed  CAS  Google Scholar 

  11. Hida J, Yoshifuji T, Tokoro T, et al. Comparison of long-term functional results of colonic J-pouch and straight anastomosis after low anterior resection for rectal cancer: a five-year follow-up. Dis Colon Rectum 2004;47:1578–85.

    Article  PubMed  Google Scholar 

  12. Nathanson DR, Espat NJ, Nash GM, et al. Evaluation of preoperative and postoperative radiotherapy on long-term functional results of straight coloanal anastomosis. Dis Colon Rectum 2003;46:888–94.

    Article  PubMed  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  14. Rullier E, Goffre B, Bonnel C, et al. Preoperative radiochemotherapy and sphincter-saving resection for T3 carcinomas of the lower third of the rectum. Ann Surg 2001;234:633–40.

    Article  PubMed  CAS  Google Scholar 

  15. 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 

  16. Dehni N, McNamara DA, Schlegel RD, et al. Clinical effects of preoperative radiation therapy on anorectal function after proctectomy and colonic J-pouch-anal anastomosis. Dis Colon Rectum 2002;45:1635–40.

    Article  PubMed  Google Scholar 

  17. Dahlberg M, Glimelius B, Graf W, Pahlman L. Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study. Dis Colon Rectum 1998;41:543–51.

    Article  PubMed  CAS  Google Scholar 

  18. Lewis WG, Williamson ME, Kuzu A, et al. Potential disadvantages of post-operative adjuvant radiotherapy after anterior resection for rectal cancer: a pilot study of sphincter function, rectal capacity and clinical outcome. Int J Colorectal Dis 1995;10:133–7.

    Article  PubMed  CAS  Google Scholar 

  19. Kollmorgen CF, Meagher AP, Wolff BG, et al. The long-term effect of adjuvant postoperative chemoradiotherapy for rectal carcinoma on bowel function. Ann Surg 1994;220:676–82.

    Article  PubMed  CAS  Google Scholar 

  20. Gervaz P, Rotholtz N, Wexner SD, et al. Colonic J-pouch function in rectal cancer patients: impact of adjuvant chemoradiotherapy. Dis Colon Rectum 2001;44:1667–75.

    Article  PubMed  CAS  Google Scholar 

  21. Fichera A, Michelassi F. Long-term prospective assessment of functional results after proctectomy with coloanal anastomosis. J Gastrointest Surg 2001;5:153–7.

    Article  PubMed  CAS  Google Scholar 

  22. Zaheer S, Pemberton JH, Farouk R, et al. Surgical treatment of adenocarcinoma of the rectum. Ann Surg 1998;227:800–11.

    Article  PubMed  CAS  Google Scholar 

  23. Hollander M, Wolfe DA. Nonparametric statistical methods. New York: John Wiley and Sons, 1973:115–20.

    Google Scholar 

  24. Kruskal WH, Wallis WA. Use of ranks in one-criterion variance analysis. J Am Stat Assoc 1952;47:583–621.

    Article  Google Scholar 

  25. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–81.

    Article  Google Scholar 

  26. Peto R, Peto J. Asymptotically efficient rank invariant procedures. J Royal Stat Soc 1972;135:185–207.

    Google Scholar 

  27. Heriot AG, Tekkis PP, Constantinides V, et al. Meta-analysis of colonic reservoirs versus straight coloanal anastomosis after anterior resection. Br J Surg 2006;93:19–32.

    Article  PubMed  CAS  Google Scholar 

  28. Ho YH, Brown S, Heah SM, et al. Comparison of J-pouch and coloplasty pouch for low rectal cancers: a randomized, controlled trial investigating functional results and comparative anastomotic leak rates. Ann Surg 2002;236:49–55.

    Article  PubMed  Google Scholar 

  29. Machado M, Nygren J, Goldman S, Ljungqvist O. Similar outcome after colonic pouch and side-to-end anastomosis in low anterior resection for rectal cancer: a prospective randomized trial. Ann Surg 2003;238:214–20.

    PubMed  Google Scholar 

  30. Dehni N, Tiret E, Singland JD, et al. Long-term functional outcome after low anterior resection: comparison of low colorectal anastomosis and colonic J-pouch-anal anastomosis. Dis Colon Rectum 1998;41:817–23.

    Article  PubMed  CAS  Google Scholar 

  31. Hallbook O, Pahlman L, Krog M, et al. Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg 1996;224:58–65.

    Article  PubMed  CAS  Google Scholar 

  32. Peeters KC, van de Velde CJ, Leer JW, et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch colorectal cancer group study. J Clin Oncol 2005;23:6199–206.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA

    Imran Hassan M.D., David W. Larson M.D., Bruce G. Wolff M.D., Robert R. Cima M.D., Heidi K. Chua M.D., Dieter Hahnloser M.D. & John H. Pemberton M.D.

  2. Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA

    Megan M. O’Byrne M.A. & Dirk R. Larson M.S.

Authors
  1. Imran Hassan M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David W. Larson M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bruce G. Wolff M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert R. Cima M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Heidi K. Chua M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dieter Hahnloser M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Megan M. O’Byrne M.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dirk R. Larson M.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. John H. Pemberton M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David W. Larson M.D..

About this article

Cite this article

Hassan, I., Larson, D.W., Wolff, B.G. et al. Impact of Pelvic Radiotherapy on Morbidity and Durability of Sphincter Preservation After Coloanal Anastomosis for Rectal Cancers. Dis Colon Rectum 51, 32–37 (2008). https://doi.org/10.1007/s10350-007-9099-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-007-9099-x

Key words

Search

Navigation