title: Impaired anastomotic healing after preoperative radiotherapy followed by anterior resection for treatment of rectal carcinoma.
abstract: BACKGROUND
  Patients with rectal carcinoma undergoing total mesorectal excision (TME) have a lower recurrence rate with preoperative radiotherapy (RT). The aim of this study was to assess the side-effects in patients who had preoperative RT compared with those who did not receive it (because of palliative resections, advanced age or refusal).
  
  
  METHODS
  From January 2001 to March 2003, 40 patients underwent resection and double-stapled anastomosis for rectal carcinoma. We compared 17 patients who received RT followed by resection and low rectal anastomosis, with 23 patients who did not have RT.
  
  
  RESULTS
  After surgery 7/17 of the patients who had received RT developed anastomotic leaks. Anastomotic leakage was seen only once in the patients who did not have RT (41% v. 4%, p = 0.006). A protective stoma, which was performed in 11 patients in the RT group, did not prevent anastomotic leakage (4/11 leakage with stoma v. 3/6 leakage without stoma, p = 0.64). Median hospital stay was longer in the RT group (17.4 v. 13.7 days, p = 0.017). There was no difference in the number of minor postoperative complications between the two groups (24% v. 22%).
  
  
  CONCLUSIONS
  Compared with surgery alone, preoperative short-term RT increased the number of anastomotic leaks and hospital stay, whether or not a protective stoma was performed.
authors.affiliation: Medisch Centrum Rijnmond Zuid, Department of Surgery, Rotterdam, The Netherlands.
authors.forename: Jefrey
authors.initials: J
authors.lastname: Vermeulen
authors.forename: Johan F
authors.initials: JF
authors.lastname: Lange
authors.forename: Erwin
authors.initials: E
authors.lastname: van der Harst
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D002277:Carcinoma / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing