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Impact of Surgical Complications Following Resection of Locally Advanced Rectal Adenocarcinoma on Adjuvant Chemotherapy Delivery and Survival Outcomes.
Jamnagerwalla, Murtaza; Tay, Rebecca; Steel, Malcolm; Keck, Jamie; Jones, Ian; Faragher, Ian; Gibbs, Peter; Wong, Rachel.
Afiliação
  • Jamnagerwalla M; 1 Department of Surgery, Eastern Health, Melbourne, Australia 2 Department of Medical Oncology, Eastern Health, Melbourne, Australia 3 Department of Surgery, Royal Melbourne Hospital, Melbourne, Australia 4 Department of Surgery, Western Health, Melbourne, Australia 5 Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia 6 Department of Medical Oncology, Western Health, Melbourne, Australia 7 Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia 8 Uni
Dis Colon Rectum ; 59(10): 916-24, 2016 Oct.
Article em En | MEDLINE | ID: mdl-27602922
ABSTRACT

BACKGROUND:

Surgical complications after resection for locally advanced rectal cancer may influence adjuvant treatment outcomes and survival. Few studies have examined this effect.

OBJECTIVE:

This study aimed to examine the impact of surgical complications on adjuvant therapy delivery and survival in patients with locally advanced rectal cancer treated with long-course chemoradiation followed by surgery.

DESIGN:

This is a retrospective analysis of a prospectively collected multicenter colorectal cancer database. SETTINGS Data were collected from the Australian Comprehensive Cancer Outcomes and Research Database. PATIENTS All patients who completed neoadjuvant chemoradiotherapy followed by surgery for locally advanced rectal cancer between January 2003 and December 2014 were selected. MAIN OUTCOME

MEASURES:

We examined the types and frequency of surgical complications and their impact on the delivery of adjuvant chemotherapy and survival.

RESULTS:

Data were available for 517 patients, of whom 147 (28%) had a surgical complication. Patients with a surgical complication were less likely to commence adjuvant chemotherapy (33% vs 66%; p = 0.0005) and more likely to have adjuvant treatment commencing more than 8 weeks from surgery (71.8% vs 21.2%; p = 0.004). Wound-related complications (p = 0.001), return to operating theater (p = 0.004), and readmission within 30 days (p = 0.02) had the most significant negative impact on the delivery of adjuvant chemotherapy. Surgical complications were significantly more likely in males (31.6% vs 20.8%, p = 0.003) and laparoscopic converted cases (47.8% vs 21.8%, p = 0.03). For the entire patient population, adjuvant chemotherapy compared with surveillance was not associated with an improved recurrence-free survival (HR, 1.06; p = 0.83) but was associated with an improved overall survival (HR, 0.53; p = 0.04).

LIMITATIONS:

This study was limited by its retrospective design.

CONCLUSION:

Surgical complications in patients having surgery following neoadjuvant chemoradiotherapy for locally advanced rectal cancer were associated with significantly reduced uptake and delays to receiving adjuvant therapy. Surgical complications, however, were not associated with either significantly reduced recurrence-free or overall survival. Adjuvant chemotherapy delivery was associated with improved overall survival.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Neoplasias Retais / Adenocarcinoma / Colectomia / Terapia Neoadjuvante / Quimiorradioterapia Adjuvante Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged País como assunto: America do norte / Oceania Idioma: En Ano de publicação: 2016 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Neoplasias Retais / Adenocarcinoma / Colectomia / Terapia Neoadjuvante / Quimiorradioterapia Adjuvante Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged País como assunto: America do norte / Oceania Idioma: En Ano de publicação: 2016 Tipo de documento: Article