title: Prognostic factors for postoperative morbidity and tumour response after neoadjuvant chemoradiation followed by resection for rectal cancer.
abstract: OBJECTIVE
  In patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation followed by rectal resection, postoperative morbidity is a significant clinical problem. Pathologic complete tumour response seems to give the best prognosis in the long term. Little is known about the factors that are associated with postoperative complications and pathologic complete response. The aim of this retrospective study was to identify and describe these factors.
  
  
  METHODS
  Ninety-nine consecutive patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiation (50 Gy and capecitabine) followed by surgery at our institute between January 2007 and May 2012 were identified. Postoperative complications were graded according to the Clavien-Dindo classification. Pathologic tumour response was categorized as complete response or no/partial response.
  
  
  RESULTS
  Postoperative complications occurred in 68 patients (69%) and grade 3-5 complications in 25 patients (25%). The 30-day and 90-day mortality were 1% (n = 1) and 2% (n = 2), respectively. A young age (p = 0.021) and a preoperative or postoperative blood transfusion (p = 0.015) independently predicted complications. Intraoperative or postoperative blood transfusion (p = 0.007) and ypT0-1 stage (p = 0.037) were independent predictors for grade 3-5 complications. Complete response rate was 22% (n = 22); 4% (n = 4) of patients showed no response. No independent factors predicting complete response were found.
  
  
  CONCLUSIONS
  Neoadjuvant chemoradiation followed by rectal resection is associated with significant postoperative morbidity but minimal postoperative mortality. A complete response rate of 22% was achieved.
authors.affiliation: Department of Surgery, Medisch Spectrum Twente, Haaksbergerstraat 55, 7500, KA, Enschede, The Netherlands.
authors.forename: Annefleur E M
authors.initials: AE
authors.lastname: Berkel
authors.forename: Dankert P
authors.initials: DP
authors.lastname: Woutersen
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
authors.forename: Joost M
authors.initials: JM
authors.lastname: Klaase
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D001803:Blood Transfusion; D000069287:Capecitabine; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D020266:Radiotherapy, Conformal; D012004:Rectal Neoplasms / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil