Open Access Research article

Intensified neoadjuvant radiochemotherapy for rectal cancer enhances surgical complications

Leif Schiffmann1*, Nicole Wedermann1, Michael Gock1, Friedrich Prall2, Gunther Klautke3, Rainer Fietkau4, Bettina Rau1 and Ernst Klar1

Author Affiliations

1 Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, Rostock 18057, Germany

2 Institute of Pathology, University of Rostock, Strempelstr. 14, Rostock 18055, Germany

3 Department of Radiotherapy, Sozialstiftung Bamberg, Buger Str. 80, Bamberg 96049, Germany

4 Department of Radiotherapy, University of Erlangen, Universitätsstr. 27, Erlangen 91054, Germany

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BMC Surgery 2013, 13:43  doi:10.1186/1471-2482-13-43

Published: 30 September 2013

Abstract

Background

Neoadjuvant radiochemotherapy has proven superior to adjuvant treatment in reducing the rate of local recurrence without impairing cancer related survival or the incidence of distant metastases. The present study aimed at addressing the effects of an intensified protocol of neoadjuvant treatment on the development of postoperative complications.

Methods

A total of 387 patients underwent oncological resection for rectal cancer in our institution between January 2000 and December 2009. 106 patients received an intensified radiochemotherapy. Perioperative morbidity and mortality were analyzed retrospectively with special attention on complication rates after intensified radio-chemotherapy. Therefore, for each patient subjected to neoadjuvant treatment a patient without neoadjuvant treatment was matched in the following order for tumor height, discontinuous resection/exstirpation, T-category of the TNM-system, dividing stoma and UICC stage.

Results

Of all patients operated for rectal cancer, 27.4% received an intensified neoadjuvant treatment. Tumor location in the matched patients were in the lower third (55.2%), middle third (41.0%) and upper third (3.8%) of the rectum. Postoperatively, surgical morbidity was higher after intensified neoadjuvant treatment. In the subgroup with low anterior resection (LAR) the anastomosis leakage rate was higher (26.6% vs. 9.7%) and in the subgroup of patients with rectal exstirpations the perineal wound infection rate was increased (42.2% vs. 18.8%) after intensified radiochemotherapy.

Conclusions

In rectal cancer the decision for an intensified neoadjuvant treatment comes along with an increase of anastomotic leakage and perineal wound infection. Quality of life is often reduced considerably and has to be balanced against the potential benefit of intensifying neoadjuvant radiochemotherapy.

Keywords:
Rectal cancer; Intensified neoadjuvant radiochemotherapy; Postoperative complications; Anastomotic leakage