Neoadjuvant radiation therapy prior to total mesorectal excision for rectal cancer is not associated with postoperative complications using current techniques Journal Article

   

Authors:	Milgrom, S. A.; Goodman, K. A.; Nash, G. M.; Paty, P. B.; Guillem, J. G.; Temple, L. K.; Weiser, M. R.; Garcia-Aguilar, J.
Article Title:	Neoadjuvant radiation therapy prior to total mesorectal excision for rectal cancer is not associated with postoperative complications using current techniques
Abstract:	Background: 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. Methods: 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. Results: 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. Conclusion: In a cohort undergoing TME using current techniques, neoadjuvant RT was not associated with 30-day postoperative morbidity or mortality. © 2014 Society of Surgical Oncology.
Keywords:	adult; aged; cancer surgery; major clinical study; intensity modulated radiation therapy; bevacizumab; cisplatin; fluorouracil; cancer combination chemotherapy; cancer adjuvant therapy; cancer radiotherapy; radiation dose; cancer staging; follow up; laparoscopic surgery; prospective study; abdominal abscess; dehydration; cohort analysis; obesity; irinotecan; postoperative complication; peripheral vascular disease; folinic acid; diabetes mellitus; comorbidity; surgical mortality; mitomycin; oxaliplatin; postoperative hemorrhage; wound infection; rectum cancer; coronary artery disease; wound complication; small intestine obstruction; rectovaginal fistula; adult respiratory distress syndrome; rectum anterior resection; rectum abdominoperineal resection; anastomosis leakage; preoperative radiotherapy; peritonitis; failure to thrive; abdominal infection; inflammatory bowel disease; human; male; female; article
Journal Title:	Annals of Surgical Oncology
Volume:	21
Issue:	7
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2014-07-01
Start Page:	2295
End Page:	2302
Language:	English
DOI:	10.1245/s10434-014-3624-7
PROVIDER:	scopus
PUBMED:	24604589
PMCID:	PMC4632492
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84902146510&partnerID=40&md5=5ad5831f14994808b5411f0ab0fb9379
Notes:	Ann. Surg. Oncol. -- Export Date: 8 July 2014 -- CODEN: ASONF -- Source: Scopus

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