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01.05.2007 | Gastrointestinal Oncology

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

verfasst von: Victor Valenti, Jose Luis Hernandez-Lizoain, Jorge Baixauli, Carlos Pastor, Javier Aristu, J. Diaz-Gonzalez, Juan Jose Beunza, Javier A. Alvarez-Cienfuegos

Erschienen in: Annals of Surgical Oncology | Ausgabe 5/2007

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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.

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

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; 91:121–3PubMedCrossRef

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

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

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; 20:1751–8PubMedCrossRef

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; 10:1218–24PubMed

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; 42:51–7CrossRef

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; 221:67–73PubMedCrossRef

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

10.

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

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; 236:75–81PubMedCrossRef

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; 41:370–6PubMedCrossRef

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; 61:293–9CrossRef

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; 42:1276–84PubMedCrossRef

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; 20:817–25PubMedCrossRef

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; 83:964–8PubMedCrossRef

17.

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

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; 30:1602–6CrossRef

19.

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

20.

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

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

22.

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

23.

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

24.

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

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; 3:423–30CrossRef

27.

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

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; 36:564–72PubMedCrossRef

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; 36:127–34PubMedCrossRef

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):1130–1134PubMedCrossRef

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; 40:131–9CrossRef

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; 71:3690–6PubMedCrossRef

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; 131:514–8PubMed

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; 348:1610–4CrossRef

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; 80:1333–6CrossRef

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; 230:544–54PubMedCrossRef

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; 38:480–7PubMedCrossRef

38.

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

39.

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

40.

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

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; 92:211–6PubMedCrossRef

42.

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

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; 165:410–20PubMedCrossRef

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; 133:894–9PubMedCrossRef

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; 47:2025–31PubMedCrossRef

Titel: Analysis of Early Postoperative Morbidity Among Patients with Rectal Cancer Treated with and without Neoadjuvant Chemoradiotherapy
verfasst von: Victor Valenti
Jose Luis Hernandez-Lizoain
Jorge Baixauli
Carlos Pastor
Javier Aristu
J. Diaz-Gonzalez
Juan Jose Beunza
Javier A. Alvarez-Cienfuegos
Publikationsdatum: 01.05.2007
Verlag: Springer-Verlag
Erschienen in: Annals of Surgical Oncology / Ausgabe 5/2007
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-006-9338-8

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