Postoperative radiotherapy-induced morbidity in rectal cancer.
OBJECTIVE
We analyzed long-term morbidity and bowel function alteration after postoperative radiotherapy for rectal cancer following resection with anastomosis.


METHODS
Thirty-seven patients who underwent surgery with intention to cure and a minimal follow-up period of 3 years were included. These patients were divided into two groups: in the first group, 14 patients received postoperative chemo-radiotherapy, 5-fluorouracil plus folinic acid, and 45 Gy plus 5 Gy boost. In the second group, there were 23 patients regarded as controls. We designed a questionnaire about their bowel function and analyzed the morbidity detected in their follow-up.


RESULTS
The group that was treated with postoperative chemo-radiotherapy had more daily bowel movements (p = 0.03) and night-time movements (p = 0.04); incontinence (69.2 vs. 17.4% in the control group; p = 0.002), and perianal skin irritation (p = 0.04) versus the control group. Although without meaningful differences, the group under treatment wore a pad more often, had more defecatory urgency, could distinguish worse gas from stool, and needed more frequently antidiarrheal measures. Major complications were present in 28.6% of the under-treatment group: three intestinal resections were performed due to actinic stenosis; one patient had a residual stercoral fistula; another had several occlusive crises solved with medical treatment.


CONCLUSIONS
Postoperative chemo-radiotherapy had a high morbidity rate, which determined a significant alteration in quality of life. Accuracy in indication is therefore necessary, as well as a consideration of other alternatives for treatment, such as preoperative chemo-radiotherapy and total mesorectal excision.
Garay Burdeos
M
M
Department of General and Digestive Surgery, LLuís Alcanyís Hospital, Xàtiva, Valencia, Spain. miguelgaray59@hotmail.com
García-Botella
M
M
Viciano Pascual
V
V
Torregrosa Macías
Md
M
Aguiló Lucia
J
J
Ata
M
M
Muñoz Alonso
M C
MC
García del Caño
J
J
D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011788:Quality of Life; D011832:Radiation Injuries / Q000209:etiology* / Q000503:physiopathology; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000503:physiopathology / Q000532:radiotherapy*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires