title: Complications after sphincter-saving resection in rectal cancer patients according to whether chemoradiotherapy is performed before or after surgery.
abstract: OBJECTIVE
  The aim of the present study was to compare the influence of preoperative chemoradiotherapy (CRT) with postoperative CRT on the incidence and types of postoperative complications in rectal cancer patients who underwent sphincter-saving resection.
  
  
  METHODS
  We reviewed 285 patients who received preoperative CRT and 418 patients who received postoperative CRT between January 2000 and December 2006.
  
  
  RESULTS
  There was no between-group difference in age, gender, or cancer stage. In the pre-CRT group, the mean level of anastomosis from the anal verge was lower (3.5 +/- 1.4 cm vs. 4.3 +/- 1.7 cm, p < 0.001) and the rate of T4 lesion and temporary diverting ileostomy was higher than in the post-CRT group. Delayed anastomotic leakage and rectovaginal fistulae developed more frequently in the pre-CRT group than in the post-CRT group (3.9% vs. 1.2%, p = 0.020, 6.5% vs. 1.3%, p = 0.027, respectively). Small bowel obstruction (arising from radiation enteritis) requiring surgical intervention was more frequent in the post-CRT group (0% in the pre-CRT group vs. 1.4% in the post-CRT group, p = 0.042). Multivariate analysis identified preoperative CRT as an independent risk factor for fistulous complications (delayed anastomotic leakage, rectovaginal fistula, rectovesical fistula), and postoperative CRT as a risk factor for obstructive complications (anastomotic stricture, small bowel obstruction). The stoma-free rates were significantly lower in the pre-CRT group than in the post-CRT group (5-year stoma-free rates: 92.8% vs. 97.0%, p = 0.008).
  
  
  CONCLUSIONS
  The overall postoperative complication rates were similar between the pre-CRT and the Post-CRT groups. However, the pattern of postoperative complications seen after sphincter- saving resection differed with reference to the timing of CRT.
authors.affiliation: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
authors.forename: Chan Wook
authors.initials: CW
authors.lastname: Kim
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Chang Sik
authors.initials: CS
authors.lastname: Yu
authors.forename: Ui Sup
authors.initials: US
authors.lastname: Shin
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Park
authors.forename: Kwang Yong
authors.initials: KY
authors.lastname: Jung
authors.forename: Tae Won
authors.initials: TW
authors.lastname: Kim
authors.forename: Sang Nam
authors.initials: SN
authors.lastname: Yoon
authors.forename: Seok-Byung
authors.initials: SB
authors.lastname: Lim
authors.forename: Jin Cheon
authors.initials: JC
authors.lastname: Kim
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000069287:Capecitabine; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004334:Drug Administration Schedule; D004751:Enteritis / Q000209:etiology / Q000601:surgery; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D007081:Ileostomy / Q000706:statistics & numerical data; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007723:Korea; D002955:Leucovorin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care; D011879:Radiotherapy Dosage; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D012006:Rectovaginal Fistula / Q000209:etiology / Q000628:therapy; D012007:Rectum / Q000601:surgery; D001747:Urinary Bladder Fistula / Q000209:etiology / Q000601:surgery; D055815:Young Adult
chemical_list: D003841:Deoxycytidine; D000069287:Capecitabine; D002955:Leucovorin; D005472:Fluorouracil