Perioperative Complications After Proctectomy for Rectal Cancer (original) (raw)
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EClinicalMedicine
Background: There is recent interest in treating locally advanced rectal cancer (LARC) patients with total neoadjuvant therapy (TNT). However, whether TNT is associated with improved overall survival (OS) remains unknown. This study compares outcomes following TNT and following neoadjuvant chemoradiation therapy (nCRT) in patients with LARC, clinically defined cT3/4 or node positive disease, using the National Cancer Database. Methods: LARC patients diagnosed between 2004-2015 were included. TNT was defined as multi-agent chemotherapy given at least 2 months before RT followed by pre-operative chemoradiation therapy and definitive surgery without adjuvant chemotherapy. nCRT was defined as pre-operative RT and chemotherapy started within 2 weeks from each other followed by definitive surgery with or without adjuvant chemotherapy. Kaplan-Meier curve with logrank test and multivariable Cox proportional hazards regression modelling were used to analyse the primary endpoint of overall survival (OS). Multivariable logistic regression modelling was used for secondary outcomes to determine if TNT is associated with pathological complete response (pCR), defined as ypT0N0, and negative circumferential resection margin (CRM). Findings: Data from 372 TNT patients and 707 nCRT patients were analysed after a 2:1 propensity matching with replacement. Kaplan-Meier curve showed that OS with TNT was comparable to that with nCRT (p = 0 • 16). The 5-year OS rates for TNT and nCRT were 73 • 6% vs. 78 • 5% (p = 0 • 20). Multivariable Cox proportional hazards regression modelling confirmed no difference in OS between TNT and nCRT (HR = 1 • 21, p = 0 • 25). With TNT, 16 • 9% patients achieved pCR, whereas 13 • 1% patients achieved pCR with nCRT (p = 0 • 12). TNT was not found to be significantly associated with pCR (OR = 1 • 36, p = 0 • 13) or negative CRM (OR = 1 • 77, p = 0 • 19) in multivariable logistic regression modelling. Interpretation: With results from current clinical trials pending, our data suggested that TNT and nCRT resulted in similar survival, while TNT led to higher pCR and CRM negative rate, albeit not statistically significant.
Annals of Surgical Oncology, 2007
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.
British Journal of Surgery, 2018
Background The influence of postoperative complications on survival in patients with locally advanced rectal cancer undergoing combined modality treatment is debatable. This study evaluated the impact of surgical complications on oncological outcomes in patients with locally advanced rectal cancer treated within the randomized CAO/ARO/AIO-94 (Working Group of Surgical Oncology/Working Group of Radiation Oncology/Working Group of Medical Oncology of the Germany Cancer Society) trial. Methods Patients were assigned randomly to either preoperative chemoradiotherapy (CRT) followed by total mesorectal excision (TME) or postoperative CRT between 1995 and 2002. Anastomotic leakage and wound healing disorders were evaluated prospectively, and their associations with overall survival, and distant metastasis and local recurrence rates after a long-term follow-up of more than 10 years were determined. Medical complications (such as cardiopulmonary events) were not analysed in this study. Resul...
Clinical outcomes among patients with non-metastatic Rectal Cancer after chemo-radiotherapy
Globally, colorectal cancer(CRC) is the third most commonly diagnosed cancer in males and the second in females, with over 1.2 million new cases and 608,700 deaths estimated to have occurred in 2008. (1)Rates are substantially higher in males than in females. Globally, the incidence of CRC varies over 10-fold. The highest incidence rates are in Australia and New Zealand, Europe and North America, and the lowest rates are found in Africa and South- entral Asia. These geographic differences appear to be attributable to differences in dietary and environmental exposures that are imposed upon a background of genetically determined susceptibility. At our center, where head and neck, breast and cervical cancers predominate, rectal cancers make for a small percentage of malignancies. In between 2009 and 2013, out of a total of 4307 patients treated with radiotherapy, carcinoma rectum accounted for only 97 cases (2.2%). Surgery remains the mainstay of curative treatment for carcinoma of the rectum. Surgical management depends on the stage and location of a tumor within the rectum. Very early cancers can be managed with limited surgery (i.e., local excision) in selected situations; however, the majority of tumors tend to present as more advanced disease and require either a low anterior resection (LAR) or abdominoperineal resection (APR). For patients with resected stage II or III rectal cancer, early randomized trials from Gastrointestinal Tumor Study Group (GITSG) and Mayo Clinic/North Central Cancer Treatment Group (NCCTG) demonstrated a significant local control and survival benefit for postoperative combined modality therapy over surgery alone. Thus, most of these patients stand to benefit from further adjuvant treatment in the form of concurrent chemoradiotherapy and adjuvant chemotherapy. Neoadjuvant or induction chemoradiotherapy is an increasingly used strategy for patients with rectal cancer. Advantages of the neoadjuvant approach include better local control, an increased likelihood of sphincter saving surgery, and a lower risk of chronic anastomotic stricture. Essential to the planning of Neoadjuvant therapy is an initial multidisciplinary assessment including the departments of surgery, radiotherapy and medical oncology. This study was conducted to evaluate our experience with Neoadjuvant and adjuvant chemoradiotherapy for rectal cancers.The study aims to estimate the local control rates and disease free survival of rectal cancer atients who undergo Neoadjuvant/adjuvant chemoradiotherapy with a curative intent at Shiridi Sai Baba Cancer ospital, Manipal.
Pre- and Post-Surgery Treatments in Rectal Cancer: A Long-Term Single-Centre Experience
Current Oncology, 2017
Background Our study evaluated long-term survival outcomes in rectal cancer patients treated with preoperative radiotherapy, and the impact on survival of concomitant and postoperative adjuvant chemotherapy (ctx), among other prognostic factors. Methods The study included 196 patients [median age: 58 years (range: 20-86 years); 63.0% men] with locally advanced rectal carcinoma and, in some cases, resectable liver metastasis. Rates of distant metastasis and local recurrence and of 5-year distant metastasis-free survival (dmfs) and overall survival (os) were determined. Results The 5-year os rate was 57.0%, with a median duration of 81.5 months (95% confidence interval: 73.7 months to 89.4 months), and the 5-year dmfs rate was 54.1%, with a median duration of 68.4 months (95% confidence interval: 40.4 months to 96.4 months). Prognostic factors for higher os and dmfs rates were downstaging (p = 0.013 and p = 0.005 respectively), radiotherapy dose (50 Gy vs. 56 Gy or 45-46 Gy, both p = 0.002), and concomitant ctx use (p = 0.004 and p = 0.001) and type (5-fluorouracil-leucovorin-folinic acid vs. tegafur-folinic acid, p = 0.034 and p = 0.043). Adjuvant ctx after neoadjuvant long-term concomitant chemoradiotherapy (ccrt) and surgery was associated with better 5-year os rates for postoperative T0-T3 disease (p = 0.003) and disease at all lymph node stages (p = 0.001). Conclusions Our findings revealed a favourable survival outcome with long-term fractionated irradiation and concomitant 5-fluorouracil-based ctx, achieving 5-year os and dmfs rates of 57.0% and 54.1% respectively. Preoperative administration of radiotherapy (50 Gy) and postoperative adjuvant ctx were associated with a significant survival benefit. Radiation doses above 50 Gy and the interval between ccrt and surgery had no significant effect on survival.
International Journal of Colorectal Disease, 2003
Neoadjuvant radiation and chemotherapy in rectal cancer reduces local recurrences and increases the rate of conservative sphincter surgery. However, an increase in postoperative morbidity and mortality has also been observed. This study analyzed the operative difficulty and postoperative complications in patients with this treatment. Patients and methods: Retrospective review of 103 patients with rectal cancer, divided into two groups: group A, 53 patients undergoing preoperative radiotherapy with 45 Gy combined with chemotherapy, and group B, 50 patients with rectal cancer who received surgery after diagnosis. Both groups were homogeneous. The two groups were compared for both technical difficulty, using intraoperative data and rate of complications.
BMC Cancer, 2013
Background: Neoadjuvant radiochemotherapy (RCT) is now part of the armamentarium of cancer of the lower and middle rectum. It is recommended in current clinical practice prior to surgical excision if the lesion is classified T3/T4 or N+. Histological complete response, defined by the absence of persistent tumor cell invasion and lymph node (ypT0N0) after pathological examination of surgical specimen has been shown to be an independent prognostic factor of overall survival and disease-free survival. Surgical excision is usually performed between 6 and 8 weeks after completion of CRT and pathological complete response rate ranges around 12%. In retrospective studies, a lengthening of the interval after RCT beyond 10 weeks was found as an independent factor increasing the rate of pathological complete response (between 26% and 31%), with a longer disease-free survival and without increasing the operative morbidity. The aim of the present study is to evaluate in 264 patients the rate of pathological complete response rate of rectal cancer after RCT by lengthening the time between RCT and surgery.
Impact of neoadjuvant chemoradiation therapy on the postoperative complication rate in rectal cancer
Journal of Cancer Research & Therapy, 2014
The treatment paradigm for locally advanced and/or node-positive middle and lower third rectal cancer (UICC stage II and III) has shifted from adjuvant to neoadjuvant chemoradiation therapy (CRT) [1, 2]. The impact of this new concept of multimodal rectal cancer therapy on the postoperative complication rate is discussed controversially in the literature [3-15]. Complications are relevant in this connection because they affect not only the immediate postoperative course but also the oncological outcome. Patients without complications after neoadjuvant CRT have a significantly better relapsefree disease and overall survival [16]. Thus the aim of this study was to evaluate the postoperative complication rate in our patient population. Patients and methods Study design A retrospective analysis was performed to examine all patients documented online who had undergone conventionally fractionated adjuvant or neoadjuvant CRT from 2001 to 2009 in conjunction with curative resection