Locally advanced rectal cancer: surgical complications after infusional chemotherapy and radiation therapy.

PURPOSE: To compare the surgical complication rate after further experience with infusional chemotherapy and radiation therapy for locally advanced rectal cancer.

MATERIALS AND

METHODS

Preoperative radiation therapy (45 Gy in 25 fractions over 5 weeks) and concurrent continuous infusion of 5-fluorouracil (300 mg.m-2.d-1) were given to 117 patients with rectal cancer. Approximately 6 weeks after therapy, surgery was performed.

RESULTS

The histopathologic cancer stages were Tis-2N0 in 30 patients (26%), T2N1 in six (5%), T3N0 in 24 (21%), T3N1 in 18 (15%), T4N0 in six (5%), and T4N1 in one (1%); a complete response to preoperative therapy was histopathologically confirmed in 32 patients. A decrease in cancer stage allowed a sphincter-saving procedure in 68 patients (58%) and abdominoperineal resection in 49 patients (42%). Only one patient developed fistula; nine patients, perioperative wound complications; and four patients, pelvic infection. In the authors' previously reported chemotherapy and radiation therapy results (same protocol), eight (22%) of 37 patients developed fistulas and five (14%) developed pelvic abscess; in the authors' previous experience with preoperative radiation therapy only (median total dose, 45 Gy; dose range, 40.0-59.4 Gy), results were similar.

CONCLUSION

Surgical complications after chemotherapy and radiation therapy are statistically significantly (P < .05) reduced with further experience.