• Qiyuan Qin, Tenghui Ma, Yanhong Deng, Jian Zheng, Zhiyang Zhou, Hui Wang, Lei Wang, and Jianping Wang.
• 1 Department of Colorectal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China 2 Department of Oncology, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China 3 Department of Radiotherapy, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China 4 Department of Radiology, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China 5 Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Sun Yat-sen University, Guangzhou, Guangdong, China.
• Dis. Colon Rectum. 2016 Oct 1; 59 (10): 934-42.

BackgroundEvidence regarding the effect of preoperative radiotherapy on anastomotic integrity remains conflicting in rectal cancer surgery. Prospective comparisons with appropriate controls are needed.ObjectiveThis study aimed to assess the impact of preoperative radiotherapy on anastomotic leakage and stenosis after rectal cancer resection.DesignThis was a post hoc analysis of a randomized controlled trial (NCT01211210).SettingsData were retrieved from the leading center of the trial, which is a tertiary hospital.PatientsThe full analysis population of 318 patients was included.InterventionsPatients were randomly assigned to receive preoperative radiation (50 Gy per 25 fractions) and 5-fluorouracil infusion, alone (arm A) or combined with oxaliplatin (arm B), or preoperative chemotherapy with 5-fluorouracil and oxaliplatin without radiation (arm C).Main Outcome MeasuresThe rates of anastomotic leakage and stenosis were calculated for each treatment arm. Multivariate analysis was used to verify the effect of preoperative radiotherapy.ResultsThe treatment arms were comparable in terms of most baseline characteristics, but more diversions were used in the chemoradiotherapy arms. Anastomotic leakage occurred in 20.2% of patients in arm A, 23.6% of patients in arm B, and 8.5% of patients in arm C (p = 0.007). The corresponding rates of stenosis were 17.0%, 18.9%, and 6.8% (p = 0.02). Multivariate analysis confirmed the correlation between preoperative radiotherapy and clinical leakage (p = 0.02), which was associated with delayed stenosis (p < 0.001). For patients undergoing chemoradiotherapy, radiation proctitis was identified as an independent risk factor for clinical leakage (p = 0.01) and stenosis (p < 0.001).LimitationsThe main limitations were discrepancies in stoma creation and chemotherapy regimen among the treatment arms.ConclusionsPreoperative radiotherapy increases the risk of anastomotic leakage and stenosis after rectal cancer resection. Clinical leakage independently contributes to the development of stenosis.

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