Short-term preoperative radiotherapy in locally advanced rectal cancer does not increase postoperative complications and improves the rate of sphincter-preserving surgery.
OBJECTIVE
The Swedish Rectal Cancer Trial (SRCT) demonstrated that a short term regimen of high-dose preoperative radiotherapy (RT) (5x5 Gy) not only reduces the risk for local recurrence, but also improves the overall survival rate. However, an increase in postoperative mortality and morbidity has also been observed. We, therefore, evaluated the early postoperative complications in patients treated with neoadjuvant RT for locally advanced rectal adenocarcinoma.


METHODS
Between 2000 and 2004, 85 patients with locally advanced rectal tumors were treated in our institution. Preoperative staging was based on computed tomography (CT) scan and, in several cases, with endorectal ultrasonography. There were 55 men and 30 women, with a median age of 68 years. Patients were retrospectively divided into two groups: group A, which included 40 patients receiving preoperative RT (25 Gy in 5 fractions), followed by surgery within one week, and group B, which included 45 patients with rectal cancer undergoing surgery immediately after diagnosis. Both groups were homogeneous regarding age, gender and preoperative stage of disease. The two groups were compared for both technical difficulties during operation and rate of postoperative complications.


RESULTS
No postoperative deaths were recorded in either group. In group A, complete pathologic response was observed in 6 (15%) patients and microscopic residual cancer was found in 8 (20%). Low anterior resection (LAR) with total mesorectal excision (TME) was performed in all group A patients, whereas 8 patients in group B underwent abdominoperineal resection (APR) (p < 0.05). Diverting stoma was performed in 7 patients of group A; this was closed 3-6 months later in all cases. Postoperative morbidity was not statistically significant between the two groups (40% versus 39%). The rate of postoperative hemorrhage, pelvic or abdominal wound infection, acute urinary infection and delayed ileus was similar. The percentage of major anastomotic leak was also similar in both groups (5 versus 6.6%).


CONCLUSIONS
Short-term preoperative RT in locally advanced rectal cancer does not increase postoperative complications and improves the rate of sphincter-preserving surgery.
Korkolis
D P
DP
First Department of Surgery, Hellenic Anticancer Institute, "Saint Savvas" Hospital, Athens, Greece.
Plataniotis
G D
GD
Gondikakis
E
E
Xinopoulos
D
D
Tzorbatzoglou
J
J
Katsilieris
J
J
Vassilopoulos
P P
PP