title: Surgery for rectal cancer after high-dose radiotherapy for prostate cancer: is sphincter preservation relevant?
abstract: OBJECTIVE
  The feasibility and outcome of sphincter-saving resection for rectal cancer were assessed in patients previously treated by high-dose radiotherapy for prostate cancer.
  
  
  METHODS
  Between 2000 and 2012, 1066 patients underwent rectal excision for rectal cancer. Of these, 236 were treated by conventional radiotherapy (45 Gy) and sphincter-saving resection (Group A) and 12 were treated by external-beam radiotherapy (EBRT) for prostate cancer (70 Gy) and sphincter-saving resection (Group B) of whom five had a metachronous and seven a synchronous cancer. The end-points were surgical morbidity, pelvic sepsis, reoperation and definitive stoma.
  
  
  RESULTS
  Tumour characteristics were similar in both groups. Surgical morbidity (67% vs 25%, P = 0.004), anastomotic leakage (50% vs 10%, P = 0.001, and reoperation (50% vs 17%, P = 0.011) were significantly higher in Group B. Multivariate analyses showed that EBRT for prostate cancer was the only independent factor for anastomotic leakage (OR = 5.12; 95% CI 1.45-18.08; P = 0.011) and definitive stoma (OR = 10.56; 95% CI 3.02-39.92; P < 0.001).
  
  
  CONCLUSIONS
  High-dose radiotherapy for prostate cancer increases morbidity from rectal surgery and the risk of a permanent stoma. This suggests that a delayed coloanal anastomosis or a Hartmann procedure should be proposed as an alternative to low anterior resection in this population.
authors.affiliation: Department of Digestive Surgery and Université Bordeaux Segalen, CHU Bordeaux, Saint André Hospital, Bordeaux, France.
authors.forename: E
authors.initials: E
authors.lastname: Buscail
authors.affiliation: Department of Digestive Surgery and Université Bordeaux Segalen, CHU Bordeaux, Saint André Hospital, Bordeaux, France.
authors.forename: V
authors.initials: V
authors.lastname: Blondeau
authors.affiliation: Department of Digestive Surgery and Université Bordeaux Segalen, CHU Bordeaux, Saint André Hospital, Bordeaux, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Adam
authors.affiliation: Department of Digestive Surgery and Université Bordeaux Segalen, CHU Bordeaux, Saint André Hospital, Bordeaux, France.
authors.forename: A
authors.initials: A
authors.lastname: Pontallier
authors.affiliation: Department of Digestive Surgery and Université Bordeaux Segalen, CHU Bordeaux, Saint André Hospital, Bordeaux, France.
authors.forename: C
authors.initials: C
authors.lastname: Laurent
authors.affiliation: Department of Digestive Surgery and Université Bordeaux Segalen, CHU Bordeaux, Saint André Hospital, Bordeaux, France.
authors.forename: E
authors.initials: E
authors.lastname: Rullier
authors.affiliation: Department of Digestive Surgery and Université Bordeaux Segalen, CHU Bordeaux, Saint André Hospital, Bordeaux, France.
authors.forename: Q
authors.initials: Q
authors.lastname: Denost
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D003082:Colectomy / Q000379:methods*; D004307:Dose-Response Relationship, Radiation; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Rectal cancer; conservative surgery; external beam radiotherapy; prostate cancer