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:
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.
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
Research background

Preoperative radiochemotherapy can improve local control of rectal cancer. However, some researchers believe it increases the incidence of surgical complications. 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 diffe-rences in their postoperative complications.

Research motivation

Some surgeons suspect that preoperative radiochemotherapy increases surgical complications, such as anastomotic leakage. As a result, surgeons are more likely to do additional diverting ileostomy for these patients. Our motivation is to determine if radiochemotherapy increases the incidence of complications or only increases the severity of complications. These findings can guide our treatment strategies.

Research objectives

To investigate surgical complications caused by three different preoperative radiotherapy regimens. It includes the incidence and severity of complications.

Research methods

This is a retrospective study. We analyzed 1197 patients with locally advanced rectal cancer between 2008 and 2010. Three hundred and forty-six patients were treated with preoperative long-course radiochemotherapy, and 259 patients received short-course radiotherapy (10 × 3 Gy) before surgery. The remaining 592 patients underwent total mesorectal excision (TME) alone without neoadjuvant therapy. The incidence of surgical complications was evaluated for up to 30 d after discharge from hospital. Severity was also studied according to Clavien–Dindo classi-fication.

Research results

The major complications were anastomotic leakage and perineal wound complications. Both long-course and short-course radiotherapy were associated with incidence of anastomotic leakage, but the severity of anastomotic leakage did not increase in patients following preoperative radiotherapy. Temporary ileostomy can reduce incidence of anastomotic leakage. Compared with TME alone, short-course radiotherapy was associated with an increase in incidence and severity of perineal wound complications. Long-course radiotherapy seemed safe regarding this complication.

Research conclusions

Radiotherapy increased incidence but not severity of anastomotic leakage. Short-course radiotherapy was also accompanied with perineal wound complications. However, intervention appeared unnecessary to ameliorate the complications. The increase of complications seems to be acceptable. Our surgeons are more likely to use diverting ileostomy for patients with preo-perative radiotherapy.

Research perspectives

We determined the advantages and disadvantages of preoperative radiotherapy, and this knowledge will inform our selection of different preoperative treatments. Our study is a retrospective study with a large sample size. In our opinion, a prospective randomized controlled study needs to be designed and performed.