• Murtaza Jamnagerwalla, Rebecca Tay, Malcolm Steel, Jamie Keck, Ian Jones, Ian Faragher, Peter Gibbs, and Rachel Wong.
• 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 University of Melbourne, Melbourne, Australia 9 Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia.
• Dis. Colon Rectum. 2016 Oct 1; 59 (10): 916-24.

BackgroundSurgical complications after resection for locally advanced rectal cancer may influence adjuvant treatment outcomes and survival. Few studies have examined this effect.ObjectiveThis 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.DesignThis is a retrospective analysis of a prospectively collected multicenter colorectal cancer database.SettingsData were collected from the Australian Comprehensive Cancer Outcomes and Research Database.PatientsAll patients who completed neoadjuvant chemoradiotherapy followed by surgery for locally advanced rectal cancer between January 2003 and December 2014 were selected.Main Outcome MeasuresWe examined the types and frequency of surgical complications and their impact on the delivery of adjuvant chemotherapy and survival.ResultsData 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).LimitationsThis study was limited by its retrospective design.ConclusionSurgical 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.

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