723 Complications after preoperative radio-chemotherapy treatment of rectal cancer

Abstract

Preoperative radio-chemotherapy is currently employed to reduce local recurrences of rectal cancer (RC). We reviewed a consecutive series treated with this modality, in order to evaluate the frequency of complications. 47 patients with localized RC were observed from 1990 to 1994. 19 patients (mean age=62; T2=3, T3=14, T4=2) received preoperative irradiation (45 Gy in 5 weeks) and chemotherapy (5-FU + Leucoverin, refused by one patient), whereas 28 patients (mean age=66.5; T1=1, T2=9, T3=17, T4=2) were treated by surgery alone. All patients had radical surgery, immediately or after (mean=5 weeks, range 3–18) preoperative treatment. Grade 3+ toxicity during preoperative treatment was observed in 8 cases (42.1%), being accounted for skin, blood, bladder, and bowel toxicity in 6, 2, 2, and 3 cases, respectively. 8 patients had radiotherapy/chemotherapy interrupted for major toxicity. One patient in the preoperative treatment group died (mortality 5.2%) for postoperative pulmonary embolism. Complications of surgery were observed in 31.5% of cases in the preoperative treatment group, and in 21.4% of cases in the immediate surgery group (<i>P</i>=0.3). Anastomotic dehiscence developed in 15.7% and 7.1% respectively; but none of them required second intervention. No difference was observed between the two groups as far as ileus time or hospitalization time were concerned. Considering the expected therapeutic benefits of preoperative treatment its side effects were relatively moderates and clinically acceptable.