Institutional members access full text with Ovid®

Preoperative Chemoradiotherapy Effects on Anastomotic Leakage After Rectal Cancer Resection: A Propensity Score Matching Analysis

Chang, Jee Suk MD*; Keum, Ki Chang MD, PhD*; Kim, Nam Kyu MD, PhD; Baik, Seung Hyuk MD, PhD; Min, Byung So MD; Huh, Hyuk MD; Lee, Chang Geol MD*; Koom, Woong Sub MD*

doi: 10.1097/SLA.0b013e31829068c5
Original Articles

Objective: To assess the effects of preoperative chemoradiotherapy (CRT) on anastomotic leakage (AL) after rectal cancer resection, using propensity score matching.

Background: Conflicting data have emerged over the last decade regarding the effect of preoperative CRT on AL.

Methods: We reviewed 1437 consecutive patients with rectal cancer who underwent low anterior resection (LAR) at our institution between 2005 and 2012. AL evaluated as grade C was the primary endpoint, as proposed by the International Study Group of Rectal Cancer in 2010. The patients were treated with (n = 360) or without (n = 1077) preoperative CRT. The total radiation dose was 50.4 Gy in 28 fractions. Multivariate and propensity score matching analyses were used to compensate for the differences in some baseline characteristics.

Results: The preoperative CRT group contained more patients with the following characteristics, older age, male sex, smoker, advanced stage tumor, lower/mid rectal tumor location, ultra-LAR, and diverting stoma, than the non-preoperative CRT group (all Ps < 0.05). Postoperative AL occurred in 91 patients (6.3%). Before propensity score matching, the incidence of AL in patients with or without preoperative CRT was 7.5% and 5.9%, respectively (P = 0.293). After propensity score matching, the 2 groups were nearly balanced except for the initial stage and the length of the surgeon's career, and the incidence of AL in patients with or without preoperative CRT was 7.5% and 8.1%, respectively (P = 0.781).

Conclusions: We did not observe that preoperative CRT increased the risk of postoperative AL after LAR in patients with rectal cancer, using propensity score matching analysis.

We reviewed 1437 patients with rectal cancer who underwent low anterior resection with or without preoperative chemoradiotherapy (CRT). In our analysis, we did not observe any significant increase of anastomotic leakage rates in preoperative CRT patients when studying not only the entire study cohort but also the propensity score–matched cohort.

Departments of *Radiation Oncology; and

Surgery, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.

Reprints: Woong Sub Koom, MD, Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea. E-mail: mdgold@yuhs.ac.

The abstract of this article was accepted for poster presentation at the 54th Annual Meeting of the American Society of Therapeutic Radiology and Oncology (ASTRO), Boston, MA, October 28–31, 2012.

Disclosure: Supported by grant A084120 from the Korea Healthcare Technology R&D Project, the Ministry for Health, Welfare & Family Affairs, the Republic of Korea, and by the Students' Association of the Graduate School of Yonsei University, funded by the Graduate School of Yonsei University. The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.