title: Outcome of rectal cancer surgery after the introduction of preoperative radiotherapy in a low-volume hospital.
abstract: BACKGROUND
  The improvement in local control by preoperative radiotherapy for rectal cancer can be at the cost of substantial morbidity.
  
  
  OBJECTIVE
  The aim of this study was to determine the impact of short-course preoperative radiotherapy on morbidity and mortality after total mesorectal excision in a low-volume hospital.
  
  
  METHODS
  From 2000 to 2007, 104 patients underwent rectal resection for a proven malignancy. Outcome parameters including anastomotic leakage rate, duration of hospital stay, and survival were retrospectively compared between patients who received radiotherapy followed by resection and patients who underwent resection alone.
  
  
  RESULTS
  Anastomotic leakage occurred in 11 of 28 patients (39%) who underwent radiotherapy and in 10 of 54 patients (19%) in the surgery-alone group (P = 0.04). The length of hospital stay was significantly longer in the radiotherapy group in comparison with the surgery-alone group (median 22 vs. 12 days; P = 0.002). Independent predictors of decreased overall survival were high American Society of Anesthesiologists classification, application of preoperative radiotherapy, necessity of Intensive Care Unit admission, and advanced pathological stage.
  
  
  CONCLUSIONS
  A negative impact of preoperative radiotherapy on morbidity and mortality after rectal cancer surgery with an annual caseload of 16 was observed. Auditing of local practices is essential for quality control and potential improvement of clinical outcome.
authors.affiliation: Department of Surgery, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1006 AE, Amsterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Doeksen
authors.forename: P J
authors.initials: PJ
authors.lastname: Tanis
authors.forename: B C
authors.initials: BC
authors.lastname: Vrouenraets
authors.forename: J A H
authors.initials: JA
authors.lastname: Gooszen
authors.forename: J J B
authors.initials: JJ
authors.lastname: van Lanschot
authors.forename: W F
authors.initials: WF
authors.lastname: van Tets
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures; D005260:Female; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D011300:Preoperative Care; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome