Impact of pelvic radiotherapy on morbidity and durability of sphincter preservation after coloanal anastomosis for rectal cancers.

Details

Serval ID
serval:BIB_97BD95EDB790
Type
Article: article from journal or magazin.
Collection
Publications
Title
Impact of pelvic radiotherapy on morbidity and durability of sphincter preservation after coloanal anastomosis for rectal cancers.
Journal
Diseases of the Colon and Rectum
Author(s)
Hassan I., Larson D.W., Wolff B.G., Cima R.R., Chua H.K., Hahnloser D., O'Byrne M.M., Larson D.R., Pemberton J.H.
ISSN
0012-3706 (Print)
ISSN-L
0012-3706
Publication state
Published
Issued date
2008
Volume
51
Number
1
Pages
32-37
Language
english
Notes
Publication types: Journal ArticlePublication Status: ppublish
Abstract
PURPOSE: This study was designed to assess the impact of pelvic radiotherapy on the incidence of complications and colostomy-free survival of patients after a coloanal anastomosis for rectal cancer.
METHODS: A total of 192 patients underwent a coloanal anastomosis between 1982 and 2001: 87 patients did not receive pelvic radiotherapy; 105 patients received pelvic radiotherapy (39 preoperative and 66 postoperative). Early and late complications requiring surgical intervention and the colostomy-free survival rate were assessed by retrospective review of patient records.
RESULTS: After a median follow-up of 62 months, 151 patients were alive. The most frequent complication was development of an anastomotic stricture (5-year rate of a stricture, 16 percent; 95 percent confidence interval, 10-21). Patients receiving pelvic radiotherapy had a higher rate of complications other than anastomotic strictures, including fecal incontinence, fistulas, abscesses, and bowel obstructions compared with patients not receiving pelvic radiotherapy (5-year rate: 20 percent (95 percent confidence interval, 10-29) vs. 5 percent (95 percent confidence interval, 0-10); P = 0.001). Patients receiving pelvic radiotherapy had a lower colostomy-free survival than did patients not receiving pelvic radiotherapy (5-year colostomy-free rate: 72 percent (95 percent confidence interval, 62-84) vs. 92 percent (95 percent confidence interval, 86-98); P < 0.001). There was no significant difference in the colostomy-free survival of patients receiving preoperative and postoperative pelvic radiotherapy.
CONCLUSIONS: After coloanal anastomosis, a significant number of patients will have complications requiring surgical intervention, and some will require a permanent colostomy. Pelvic radiotherapy, whether it is administered preoperatively or postoperatively, significantly increases the need for a permanent colostomy.
Keywords
Adult, Aged, Aged, 80 and over, Anal Canal/surgery, Anastomosis, Surgical, Chi-Square Distribution, Colon/surgery, Colostomy/statistics & numerical data, Female, Humans, Male, Middle Aged, Postoperative Complications, Rectal Neoplasms/radiotherapy, Rectum/physiopathology, Risk Factors, Statistics, Nonparametric, Survival Analysis, Treatment Outcome
Pubmed
Web of science
Create date
07/10/2014 15:22
Last modification date
20/08/2019 15:59
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