Outcome of rectal cancer surgery after the introduction of preoperative radiotherapy in a low-volume hospital.

ABSTRACT

BACKGROUND: The improvement in local control by preoperative radiotherapy for rectal cancer can be at the cost of substantial morbidity. AIM OF THE STUDY The aim of this study was to determine the impact of short-course preoperative radiotherapy on morbidity and mortality after total mesorectal excision in a low-volume hospital. METHODS: From 2000 to 2007, 104 patients underwent rectal resection for a proven malignancy. Outcome parameters including anastomotic leakage rate, duration of hospital stay, and survival were retrospectively compared between patients who received radiotherapy followed by resection and patients who underwent resection alone. RESULTS: Anastomotic leakage occurred in 11 of 28 patients (39%) who underwent radiotherapy and in 10 of 54 patients (19%) in the surgery-alone group (P = 0.04). The length of hospital stay was significantly longer in the radiotherapy group in comparison with the surgery-alone group (median 22 vs. 12 days; P = 0.002). Independent predictors of decreased overall survival were high American Society of Anesthesiologists classification, application of preoperative radiotherapy, necessity of Intensive Care Unit admission, and advanced pathological stage. CONCLUSIONS: A negative impact of preoperative radiotherapy on morbidity and mortality after rectal cancer surgery with an annual caseload of 16 was observed. Auditing of local practices is essential for quality control and potential improvement of clinical outcome.