Previous radiation for prostate neoplasm alters surgical and oncologic outcomes after rectal cancer surgery.
BACKGROUND
Previous radiation for prostate cancer (PC) contra-indicates neoadjuvant chemoradiotherapy for rectal cancer (RC) because of risk of cumulative radiation dose toxicity. Postoperative outcomes after proctectomy have not been well studied in these patients who did not receive optimal treatment.


METHODS
Eighty-four consecutive male patients underwent surgery for stage II-III mid or low RC between 2002 and 2011. Patients who previously received radiation for PC (n = 8) and patients who had not previously undergone radiation for PC but who received neoadjuvant chemoradiotherapy for RC (n = 64) were retrospectively compared.


RESULTS
Previous radiation for PC was an independent factor that significantly increased intraoperative (25% vs. 1.6%, P = 0.002) and postoperative morbidities (62.5% vs. 28.1%, P = 0.028), anastomotic leakage (62.5% vs. 12.5%, P < 0.001) and definitive stoma rates (25% vs. 17.4%, P = 0.022). It significantly altered median overall survival (32.0 vs. 130.6 months, P = 0.05) and local recurrence-free survival rates (14.0 months vs. "median not reached," P = 0.016).


CONCLUSIONS
This is the first report of altered survival rates after proctectomy in patients who had previously received radiation for PC. Postoperative morbidity and definitive defunctioning stoma rates were significantly increased in these patients with poor prognoses. Therapeutic strategies should thus be individualized. Large, multicenter cohort studies are needed.
Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France.
Marlène
M
Guandalino
Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France.
Aurélien
A
Dupré
Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France.
Marie
M
François
Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France.
Bertrand
B
Leroy
Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France.
Olivier
O
Antomarchi
Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France.
Emmanuel
E
Buc
Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France.
Anne
A
Dubois
Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France.
Laurent
L
Guy
Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France.
Denis
D
Pezet
Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France.
Johan
J
Gagnière
D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000368:Aged; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000209:etiology*; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
colorectal surgery; neoadjuvant therapy; prostate neoplasms; rectal neoplasms