Perioperative Complications After Proctectomy for Rectal Cancer (original) (raw)

Objective: Investigate the association between neoadjuvant treatment strategy and peri-operative complications in patients undergoing proctectomy for non-metastatic rectal cancer. Summary Background Data: Neoadjuvant short-course radiation with consolidation chemotherapy (SC-TNT) is an alternative to neoadjuvant chemoradiation (CRT) for rectal cancer. Some have argued that short-course radiation and extended radiation-to-surgery intervals increase operative difficulty and complication risk. However, the association between SC-TNT and surgical complications has not been previously investigated. Methods: This single-center retrospective cohort study included patients undergoing total mesorectal excision for non-metastatic rectal cancer after SC-TNT or CRT between 2010 and 2018. Univariate analysis of severe peri-operative morbidity (POM) and multiple secondary outcomes, including overall POM, intra-operative complications, and resection margins, was performed. Logistic regression of severe POM was also performed. Results: Of 415 included patients, 156 (38%) received SC-TNT and 259 (62%) received CRT. The cohorts were largely similar, though patients with higher tumors (69.9% vs. 47.5%, p<0.0001) or node-positive disease (76.9% vs. 62.6%, p=0.004) were more likely to receive SC-TNT. We found no difference in incidence of severe POM (9.6% SC-TNT vs. 12.0% CRT, p=0.46) or overall POM (39.7% SC-TNT vs. 37.5% CRT, p=0.64) between cohorts. Neoadjuvant regimen was also not associated with a difference in severe POM (OR 0.42, 95% CI 0.04-4.70, p=0.48) in multivariate analysis. There was no significant association between neoadjuvant regimen and any secondary outcome. Conclusion: In rectal cancer patients treated with SC-TNT and proctectomy, we found no significant association with POM compared to patients undergoing CRT. SC-TNT does not significantly increase the risk of POM compared to CRT.