LOCALLY ADVANCED RECTAL-CANCER - SURGICAL COMPLICATIONS AFTER INFUSIONAL CHEMOTHERAPY AND RADIATION-THERAPY

PURPOSE: To compare the surgical complication rate after further exper ience with infusional chemotherapy and radiation therapy for locally a dvanced rectal cancer. MATERIALS AND METHODS: Preoperative radiation t herapy (45 Gy in 25 fractions over 5 weeks) and concurrent continuous infusion of 5-fluorouracil (300 mg . m(-2) . d(-1)) were given to 117 patients with rectal cancer. Approximately 6 weeks after therapy, surg ery was performed. RESULTS: The histopathologic cancer stages were Tis -2N0 in 30 patients (26%), T2N1 in six (5%), T3N0 in 24 (21%), T3N1 in 18 (15%), T4N0 in six (5%), and T4N1 in one (1%); a complete response to preoperative therapy was histopathologically confirmed in 32 patie nts. A decrease in cancer stage allowed a sphincter-saving procedure i n 68 patients (58%) and abdominoperineal resection in 49 patients (42% ). Only one patient developed fistula; nine patients, perioperative wo und complications; and four patients, pelvic infection. In the authors ' previously reported chemotherapy and radiation therapy results (same protocol), eight (22%) of 37 patients developed fistulas and five (14 %) developed pelvic abscess; in the authors' previous experience with preoperative radiation therapy only (median total dose, 45 Gy; dose ra nge, 40.0-59.4 Gy), results were similar. CONCLUSION: Surgical complic ations after chemotherapy and radiation therapy are statistically sign ificantly (P < .05) reduced with further experience.