Late Complications after Preoperative Chemoradiation for Rectal Cancers

Seung-Hyun LEE; Chul-Min LEE; Byung-Kwon AHN; Sung-Uhn BAEK

OBJECTIVES:

To compare the late complications after operations for rectal cancers with and without preoperative chemoradiation.

METHODS:

From January 2003 to December 2005, 55 patients underwent operation after preoperative chemoradiation for adenocarcinoma of the rectum. All of them received the full scheduled dose of radiation with concurrent chemotherapy. The interval between preoperative chemoradiation and surgery was 4-6 weeks. 47 patients who had tumors below 8 cm from the anal verge were enrolled into the study group (CRT group). During same period, we selected 153 patients who had adenocarcinoma of the rectum below 8cm from the anal verge, underwent surgery alone without postoperative radiotherapy non-CRT group). We compared the early and the late postoperative complications between the CRT group and the non-CRT group.

RESULTS:

Of the late complications, the incidence of anastomotic stricture was significantly higher in the CRT group (P = 0.018). The incidence of anal stricture was higher in the CRT group (P = 0.164). In the CRT group, 3 cases (17.6%) had failed to preserve the anal function due to moderate or severe anal stricture. Of the 3 cases, protective ileostomy was persistent in 2 cases, colostomy was performed in one case. Otherwise, the late complications of the CRT group were intestinal obstruction in 2 cases (4.3%), lymph edema in 2 cases (4.3%).

CONCLUSION:

In CRT group, failure of anal function preservation due to anastomotic stricture or anal stricture was more common and serious than non-CRT group. We emphasize the need for careful management for postoperative anal stricture after preoperative chemoradiation.

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