Preoperative combined radiotherapy and chemotherapy for rectal cancer doesnot affect early postoperative morbidity and mortality in low anterior resection

PURPOSE: It is not yet known whether preoperative combined radiotherapy and chemotherapy for rectal cancer affects postoperative mortality and morbidi ty. We therefore evaluated early postoperative complications in patients gi ven adjuvant radiotherapy and chemotherapy before surgery for middle and lo wer rectal adenocarcinoma. METHODS: Between 1994 and 1998, 41 patients unde rwent combined preoperative pelvic radiotherapy and chemotherapy at our ins titution. Most of the patients had 45 Gy (1.8 Gy/day/25 fractions) during f ive weeks plus 5-fluorouracil (350 mg/m(2)/day) and low-dose leucovorin (10 mg/m2/day) bolus on Days 1 to 5 and 29 to 33. Surgery was performed four t o six weeks after completion of adjuvant therapy. The 41 patients (Group A) were retrospectively compared with 30 patients (Group B) who, in the same period, underwent surgery without preoperative adjuvant therapy. The groups were homogeneous for age, gender, preoperative risk factors, operating sur geon, and pathologic stage. Mean distance of the tumor from the anal verge was shorter in Group A patients (P = 0.031). RESULTS: There were seven majo r postoperative complications in each group. No significant differences wer e found between the groups for morbidity and mortality rates. Considering a ll patients, more postoperative complications were found in patients scored as American Society of Anesthesiologists 3, in those with a preoperative h emoglobin value < 10 g/dl, and in those without a diverting stoma (P = 0.00 48, P = 0.0453, and P = 0.0033, respectively). At multivariate analysis, in dependent predictors of major complications were American Society of Anesth esiologists score (relative risk, 343; P = 0.022), diverting stoma (relativ e risk, 159; P = 0.010), type of surgical procedure (relative risk, 38.9; P = 0.048), preoperative hemoglobin value (relative risk, 9.72; P = 0.061), and intraoperative blood loss (relative risk, 1; P = 0.027). In Group A pat ients, the absence of diverting stomas was associated with major postoperat ive complications (P = 0.0307), and independent predictors of major complic ations were American Society of Anesthesiologists score (relative risk, 56; P = 0.111) and absence of a diverting stoma (relative risk, 22.42; P = 0.2 22). CONCLUSION: Early postoperative complications after resection for midd le and lower rectal adenocarcinoma are affected by intraoperative and preop erative risk factors and absence of diverting stomas, but not by preoperati ve adjuvant therapy.