Preoperative radiotherapy for patients with rectal cancer: a risk factor for non-reversal of ileostomy caused by stenosis or stiffness proximal to colorectal anastomosis.

Hongbo Zhu,Bingjun Bai,Min Chen,Weifang Mao,Xuefeng Huang,Lina Shan,Xiaowei Wang

doi:10.18632/oncotarget.20602

Abstract

The influence of radiotherapy on permanent stoma and the bowel proximal to anastomosis was not well investigated. The current study aimed to analyze the effect of preoperative radiotherapy on colorectal anastomosis and incidence of non-reversal ileostomy. A total of 184 eligible patients with rectal cancer undergoing loop ileostomy were included. Patients were well selected by excluding some confounding factors and divided into two groups according to whether they received preoperative radiotherapy.Patients with preoperative radiotherapy had higher incidence of non-reversal stoma (12.8%, P = 0.004) and stenosis or stiffness around anastomosis (21.1%, P < 0.01) including 13 patients with stenosis or stiffness proximal to anastomosis. Stenosis proximal to anastomosis was different from anastomotic stricture caused by surgery and could be described by imaging findings. Preoperative radiotherapy prolonged the interval to closure (P = 0.008) and was defined as a significant risk factor for permanent stoma (HR, 0.627; 95% CI, 0.405–0.973; P = 0.04) by multivariate Cox regression analysis. In conclusion, Preoperative radiotherapy increased incidence of non-reversal ileostomy and stenosis or stiffness proximal to anastomosis in rectal cancer patients with radical resection and diverting ileostomy.

Highlights

Multidisciplinary management has been applied in rectal cancer (RC) with the precise preoperative staging, advancement of surgical technique, neoadjuvant chemoradiation therapy (NCRT) and adjuvant therapy, which results in an improved disease-free survival and overall survival [1, 2]
The baseline characteristics of all the patients are shown in Table 1. 184 patients were divided into two groups according to whether receiving preoperative radiotherapy (PRT+) or not (PRT-), which contained 133 and 51 patients, respectively
For local advanced rectal cancer, in which the use of NRCT was recommended by NCCN/ESMO guidelines, low anterior resection (LAR) plus a diverting loop ileostomy was routinely used to avoid severe anastomotic complications [4, 12]

Summary

Introduction

Multidisciplinary management has been applied in rectal cancer (RC) with the precise preoperative staging, advancement of surgical technique, neoadjuvant chemoradiation therapy (NCRT) and adjuvant therapy, which results in an improved disease-free survival and overall survival [1, 2]. Patients with local advanced low or middle rectal cancer tend to choose NCRT and total mesorectal excision (TME) with sphincter preservation rather than abdominoperineal resection. NCRT offers plenty of advantages, including decreased tumor size, downgraded tumor stage even pathologic complete response (pCR), reduced local recurrence rate and more sphincter preservation [3]. The complications including anastomotic leakage, fecal incontinence and fistula may result in an unreversed loop stoma or a permanent end colostomy, which greatly reduces the quality of patients’ life [6]. Age, anastomotic level, local recurrence and radiotherapy are related to permanent stomas. The role of preoperative radiotherapy as a risk factor for permanent stomas still remains controversial [9, 11]

Methods

Results

Conclusion