The impact of pre- or postoperative radiochemotherapy on complication following anterior resection with en bloc excision of female genitalia for T4 rectal cancer.
OBJECTIVE
The aim of the study was to assess the mortality and morbidity following extended anterior resection with excision of internal female genitalia combined with pre- or postoperative chemoradiotherapy in women with extensive rectal cancer.


METHODS
The study included a consecutive series of 21 women with T4 adenocarcinoma of the rectum infiltrating the reproductive organs treated with curative intent between 1997 and 2003. All patients had an extended anterior sphincter preserving resection of the rectum (total mesorectal excision) and hysterectomy with or without posterior vaginal wall excision. In all patients, surgery was combined with adjuvant radiochemotherapy. Ten patients received preoperative radiotherapy (50.4 Gy) concurrently with two courses of chemotherapy [fluorouracil with folinic acid (FA)] followed by surgery within 6-8 weeks and subsequently four courses of postoperative chemotherapy. Eleven received postoperative chemoradiotherapy (50.4 Gy plus fluorouracil with FA).


RESULTS
There was no postoperative mortality. Postoperative complications were observed in 57% patients (early in 14% and late in 52%). These included: anterior resection syndrome with anorectal dysfunction in 52% (requiring proximal diversion in 5%), urinary complications in 24% (complete incontinence requiring a permanent catheter in 5%). In addition, postoperative acute bleeding requiring relaparotomy, delayed wound healing caused by superficial infection, anastomotic leakage, prolonged bowel paralysis, benign rectovaginal fistula and anastomotic stricture occurred (5% each). The risk of postoperative morbidity (52%) was similar for patients with or without preoperative radiochemotherapy.


CONCLUSIONS
Despite this aggressive therapeutic approach, most postoperative complications were transient or could be treated. Preoperative radiochemotherapy did not increase the risk of morbidity.
Szynglarewicz
B
B
2nd Department of Surgical Oncology, Lower Silesian Oncology Center-Regional Comprehensive Cancer Center, Wroclaw, Poland.
Matkowski
R
R
Gisterek
I
I
Forgacz
J
J
Lacko
A
A
Pudelko
M
M
Kornafel
J
J
D000230:Adenocarcinoma / Q000601:surgery / Q000628:therapy*; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005836:Genitalia, Female / Q000473:pathology / Q000601:surgery; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies
D000970:Antineoplastic Agents