Effect of neoadjuvant chemoradiotherapy on the healing of anastomosis following low anterior resection in locally advanced rectal cancer / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the effect of the neoadjuvant chemoradiotherapy (NCR) on the healing of anastomosis following low anterior resection in patients with locally advanced rectal cancer.</p><p><b>METHODS</b>Between May 2001 and August 2007, 192 patients with T3 and T4 low rectal cancer (distance from the tumor to anal verge </= 6 cm) enrolled in the study. All patients were subjected to preoperative radiotherapy to pelvis, with a total dose of 40 - 46 Gy in 20 days fractions of 2 Gy each in 4 weeks and simultaneously combined with oral capecitabine (CAP) of 1250 mg/m(2) bid continuously for 10 weeks up to surgery. The patients were operated on 6 weeks after the end of radiotherapy according to the rule of TME technique.</p><p><b>RESULTS</b>All patients fulfilled the study. Of the patients, 17 cases were diagnosed tumor free after the neoadjuvant therapy and were not operated on. Other 24 cases were found got complete tumor response with pathological examination after the operation. A total of 41 cases (21.4%) got complete tumor response with the neoadjuvant therapy. Surgery was performed in 175 patients, and 166 patients (95.3%) with sphincter-saving resection, 134 patients with low anterior resection (LAR, double stapling technique) and 32 patients with Park's endoanal anastomosis. Six patients were operated with abdomino-perineal resection (APR) and 3 patients with Hartmann's procedure. Anastomotic leakage was found in 9 patients (5.1%), 6 patients (4 cases of rectovaginal leakage) with LAR(double stapling technique) and 3 patients (1 case of rectovaginal leakage) with Parks technique (P > 0.05). Anastomotic leakage occurred in 2 - 10 days post operation, and were managed properly and got desirable results.</p><p><b>CONCLUSION</b>Neoadjuvant chemoradiotherapy would not affect the healing of anastomosis obviously if being applied reasonably in locally advanced low rectal cancer.</p>