Published online May 15, 2019. doi: 10.4251/wjgo.v11.i5.393
Peer-review started: December 27, 2019
First decision: January 11, 2019
Revised: March 16, 2019
Accepted: March 26, 2019
Article in press: March 26, 2019
Published online: May 15, 2019
Preoperative radiochemotherapy can improve local control of rectal cancer. However, some researchers believe it increases the incidence of surgical complications. Patients with locally advanced rectal cancer receive three different treatments in our hospital, including long-course radiochemotherapy, short-course radiotherapy, and surgery directly. We can compare diffe-rences in their postoperative complications.
Some surgeons suspect that preoperative radiochemotherapy increases surgical complications, such as anastomotic leakage. As a result, surgeons are more likely to do additional diverting ileostomy for these patients. Our motivation is to determine if radiochemotherapy increases the incidence of complications or only increases the severity of complications. These findings can guide our treatment strategies.
To investigate surgical complications caused by three different preoperative radiotherapy regimens. It includes the incidence and severity of complications.
This is a retrospective study. We analyzed 1197 patients with locally advanced rectal cancer between 2008 and 2010. Three hundred and forty-six patients were treated with preoperative long-course radiochemotherapy, and 259 patients received short-course radiotherapy (10 × 3 Gy) before surgery. The remaining 592 patients underwent total mesorectal excision (TME) alone without neoadjuvant therapy. The incidence of surgical complications was evaluated for up to 30 d after discharge from hospital. Severity was also studied according to Clavien–Dindo classi-fication.
The major complications were anastomotic leakage and perineal wound complications. Both long-course and short-course radiotherapy were associated with incidence of anastomotic leakage, but the severity of anastomotic leakage did not increase in patients following preoperative radiotherapy. Temporary ileostomy can reduce incidence of anastomotic leakage. Compared with TME alone, short-course radiotherapy was associated with an increase in incidence and severity of perineal wound complications. Long-course radiotherapy seemed safe regarding this complication.
Radiotherapy increased incidence but not severity of anastomotic leakage. Short-course radiotherapy was also accompanied with perineal wound complications. However, intervention appeared unnecessary to ameliorate the complications. The increase of complications seems to be acceptable. Our surgeons are more likely to use diverting ileostomy for patients with preo-perative radiotherapy.
We determined the advantages and disadvantages of preoperative radiotherapy, and this knowledge will inform our selection of different preoperative treatments. Our study is a retrospective study with a large sample size. In our opinion, a prospective randomized controlled study needs to be designed and performed.