POSTOPERATIVE MORTALITY IN RECTAL-CANCER TREATED WITH OR WITHOUT PREOPERATIVE RADIOTHERAPY - CAUSES AND RISK-FACTORS

Adjuvant preoperative radiotherapy in patients with rectal cancer impr oves local control and possibly overall survival. However, an increase d postoperative mortality rate after radiotherapy has been observed in some trials. This study was based on 1399 patients in two randomized trials of radiotherapy. It reviewed the causes of death after operatio n and attempted to identify risk factors for postoperative mortality i n patients with rectal cancer treated with or without high-dose (5 X 5 Gy) preoperative radiotherapy. The majority of deaths were from cardi ovascular disease or infection. The risk of postoperative mortality wa s significantly increased in patients irradiated with a two-portal tec hnique to a relatively large volume compared with those not given radi otherapy, but not in those irradiated with a four-portal technique to a limited volume. Age, sex, tumour stage and coexistent cardiovascular disease were independent risk factors for postoperative mortality. Th e risk of postoperative death in patients with rectal cancer is relate d to the preoperative radiotherapy technique.