Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2019; 11(5): 393-403
Published online May 15, 2019. doi: 10.4251/wjgo.v11.i5.393
Surgical complications after different therapeutic approaches for locally advanced rectal cancer
Tian-Cheng Zhan, Da-Kui Zhang, Jin Gu, Ming Li
Tian-Cheng Zhan, Jin Gu, Ming Li, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Colorectal Surgery, Peking University Cancer Hospital and Institute, Beijing Cancer Hospital, Beijing 100142, China
Da-Kui Zhang, Department of General Surgery, China–Japan Friendship Hospital, Beijing 100029, China
Author contributions: Li M and Zhan TC contributed to the design and organization of the study, the acquisition of data, the analysis and interpretation of data, and drafting the article; Gu J and Zhang DK contributed to the design and organization of the study, the acquisition of data, and drafting the article.
Informed consent statement: This study is a retrospective study. As confirmed by the Ethics Committee of Beijing Cancer Hospital, no additional informed consent statement is required.
Conflict-of-interest statement: There are no conflicts of interest or source of funding.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ming Li, MD, Professor, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Colorectal Surgery, Peking University Cancer Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. limingmd@126.com
Telephone: +86-10-88196086 Fax: +86-10-88196086
Received: December 26, 2019
Peer-review started: December 27, 2019
First decision: January 11, 2019
Revised: March 16, 2019
Accepted: March 26, 2019
Article in press: March 26, 2019
Published online: May 15, 2019
Processing time: 139 Days and 19.8 Hours
Abstract
BACKGROUND

Preoperative radiochemotherapy is widely used in locally advanced rectal cancer. It can improve local control of rectal cancer. However, some researchers believe it increases the incidence of surgical complications. They doubt its safety. Patients with locally advanced rectal cancer receive three different treatments in our hospital, including long-course radiochemotherapy, short-course radiotherapy, and surgery directly. We can compare their differences in postoperative complications.

AIM

To investigate surgical complications caused by different preoperative radiotherapy regimens.

METHODS

We retrospectively analyzed 1197 patients admitted between 2008 and 2010 with locally advanced rectal cancer. Three hundred and forty-six patients were treated with preoperative long-course radiochemotherapy (25 × 2 Gy) followed by total mesorectal excision (TME) 6–8 wk later, and 259 patients received short-course radiotherapy (10 × 3 Gy) and subsequently TME 7–10 d later. The remaining 592 patients underwent TME alone without neoadjuvant therapy. According to Clavien–Dindo classification, surgical complications were evaluated for up to 30 d after discharge from hospital.

RESULTS

There were no deaths in 30 d in all groups after treatment. The major complications were anastomotic leakage and perineal wound complications. The results suggested that both long-course [odds ratio (OR) = 3.624, 95% confidence interval (CI): 1.689–7.775, P = 0.001] and short-course (OR = 5.150, 95%CI: 1.828–14.515, P = 0.002) radiotherapy were associated with anastomotic leakage. Temporary ileostomy was a protective factor for anastomotic leakage (OR = 6.211, 95%CI: 2.525–15.385, P < 0.001). The severity of anastomotic leakage did not increase in patients following preoperative radiotherapy (P = 0.411). Compared with TME alone, short-course radiotherapy was associated with an increase in perineal wound complications (OR = 5.565, 95%CI: 2.203–14.057, P < 0.001), but long-course radiotherapy seemed safe regarding this complication (OR = 1.692, 95%CI: 0.651–4.394, P = 0.280). Although the severity of perineal wound complications increased in patients following short-course radiotherapy (P < 0.001), additional intervention was not necessary.

CONCLUSION

Radiotherapy increased the incidence but not severity of anastomotic leakage. Short-course radiotherapy was also accompanied with perineal wound complications, but intervention appeared unnecessary to ameliorate the complications.

Keywords: Rectal cancer; Radiotherapy; Surgical complications; Total mesorectal excision; Anastomotic leakage

Core tip: Preoperative radiotherapy is a promising treatment for rectal cancer. Our aim is to investigate surgical complications caused by radiotherapy. Both long-course and short-course radiotherapy increased the incidence of anastomotic leakage but did not affect the severity. Additional ileostomy was an effective method to reduce the risk of anastomotic leakage. Short-course radiotherapy was accompanied with increased incidence of perineal wound complications, but intervention appeared unnecessary to ameliorate the complications.