Influence of Neoadjuvant Radiotherapy on Anastomotic Leak After Restorative Resection for Rectal Cancer
Purpose This study was undertaken to determine whether neoadjuvant radiotherapy is associated with an increased risk of anastomotic leak for rectal cancer patients undergoing restorative resection. Methods From 1980 to 2010, patients who underwent restorative resection for rectal cancer (tumors with...
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| Veröffentlicht in: | Journal of gastrointestinal surgery 2012-09, Vol.16 (9), p.1750-1757 |
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| creator | Nisar, Pasha J. Lavery, Ian C. Kiran, Ravi P. |
| description | Purpose
This study was undertaken to determine whether neoadjuvant radiotherapy is associated with an increased risk of anastomotic leak for rectal cancer patients undergoing restorative resection.
Methods
From 1980 to 2010, patients who underwent restorative resection for rectal cancer (tumors within 15 cm of anal verge) were identified from a prospective institutional database and grouped based on whether they received neoadjuvant radiotherapy (+RT) or not (−RT). The main outcome was anastomotic leak documented by imaging (contrast leak), intra-operative or clinical (signs of peritonitis) findings and confirmed by staff surgeon assessment. Using multivariate (MV) analysis risk factors for leak were identified, presented as OR (95 % CI).
Results
One thousand eight hundred sixty-two patients were included in the analysis, 28 % in the +RT group. Eighty-six percent of +RT patients received neoadjuvant chemoradiotherapy. The overall leak rate was 6.3 %, with no significant difference in +RT and −RT groups (8 % vs 5.7 %,
p
= 0.06). The +RT group had a lower mean age at surgery (58 vs 63 year,
p
|
| doi_str_mv | 10.1007/s11605-012-1936-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_1507441552</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3246434621</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-e94144446c54caf33b6f15895a7ac991138fbc098677e0b9eadfa748760c02ba3</originalsourceid><addsrcrecordid>eNp1kMFqGzEQhkVISFI3D9BLEPS87Yx2Je0ejWlSg2nAtNCbmJUlZ1175Wq1Br99ZJyUXjKXGWa--Uf6GfuE8AUB9NcBUYEsAEWBTakKuGC3WOuyqJRQl7mGBgsh5e8b9mEYNgCoAetrdiOEripV6lu2nvd-O7reOh48_-ECrTbjgfrEl7TqQnp2kfZHHno-7WlIYRdSZ_nC0R8-9clFvnS5Gyl1B3eqnU1dhn04TWyiLZ9RFo8f2ZWn7eDuXvOE_Xr49nP2vVg8Pc5n00VhSy1S4ZoKqxzKysqSL8tWeZR1I0mTbRrEsvathaZWWjtoG0crT7qqtQILoqVywj6fdfcx_B3z28wmjLHPJw1KyL9GKUWm8EzZGIYhOm_2sdtRPBoEc7LWnK012VpzstZA3rl_VR7bnVv923jzMgPiDAx51K9d_O_0u6ovjD-ELQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1507441552</pqid></control><display><type>article</type><title>Influence of Neoadjuvant Radiotherapy on Anastomotic Leak After Restorative Resection for Rectal Cancer</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Nisar, Pasha J. ; Lavery, Ian C. ; Kiran, Ravi P.</creator><creatorcontrib>Nisar, Pasha J. ; Lavery, Ian C. ; Kiran, Ravi P.</creatorcontrib><description><![CDATA[Purpose
This study was undertaken to determine whether neoadjuvant radiotherapy is associated with an increased risk of anastomotic leak for rectal cancer patients undergoing restorative resection.
Methods
From 1980 to 2010, patients who underwent restorative resection for rectal cancer (tumors within 15 cm of anal verge) were identified from a prospective institutional database and grouped based on whether they received neoadjuvant radiotherapy (+RT) or not (−RT). The main outcome was anastomotic leak documented by imaging (contrast leak), intra-operative or clinical (signs of peritonitis) findings and confirmed by staff surgeon assessment. Using multivariate (MV) analysis risk factors for leak were identified, presented as OR (95 % CI).
Results
One thousand eight hundred sixty-two patients were included in the analysis, 28 % in the +RT group. Eighty-six percent of +RT patients received neoadjuvant chemoradiotherapy. The overall leak rate was 6.3 %, with no significant difference in +RT and −RT groups (8 % vs 5.7 %,
p
= 0.06). The +RT group had a lower mean age at surgery (58 vs 63 year,
p
< 0.001), more male (75 % vs 62 %,
p
< 0.001) and more ASA 3/4 (44 % vs 35 %,
p
< 0.001) patients, greater use of defunctioning ostomy (87 % vs 44 %,
p
< 0.001) and colo-anal anastomosis (77 % vs 34 %,
p
< 0.001). Mean tumor distance from the anal verge was lower in +RT group (6.6 vs 9.7 cm,
p
< 0.001). On MV analysis, male sex (OR 1.64 (1.03–2.62),
p
= 0.038), ASA 4 (OR 4.70 (2.07–10.7),
p
< 0.001), tumor distance from anal verge ≤ 5 cm (OR 2.49 (1.37–4.52),
p
= 0.003), and tumor size at surgery ≥ 4 cm (OR 1.75 (1.15–2.65),
p
= 0.009) were independently associated with leak. +RT was not independently associated with leak (OR 1.44 (0.85–2.46),
p
= 0.18), while defunctioning ostomy did not reduce leak occurrence (OR 0.75 (0.44–1.28),
p
= 0.29).
Conclusions
The findings suggest that neoadjuvant radiotherapy is not independently associated with an anastomotic leak for rectal cancer patients undergoing restorative resection and support a selective policy towards the use of a defunctioning ostomy on a case by case basis based on intra-operative judgment and consideration of tumor location, size, and patient characteristics.]]></description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-012-1936-0</identifier><identifier>PMID: 22744637</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Aged ; Anastomotic Leak - etiology ; Cancer surgery ; Colectomy - adverse effects ; Colorectal cancer ; Colostomy ; Female ; Gastroenterology ; Humans ; Male ; Medicine ; Medicine & Public Health ; Meta-analysis ; Middle Aged ; Mortality ; Neoadjuvant Therapy - adverse effects ; Original Article ; Ostomy ; Patients ; Quality of Life ; Radiation therapy ; Radiotherapy, Adjuvant - adverse effects ; Rectal Neoplasms - radiotherapy ; Rectal Neoplasms - surgery ; Risk Factors ; Surgeons ; Surgery ; Surgical anastomosis</subject><ispartof>Journal of gastrointestinal surgery, 2012-09, Vol.16 (9), p.1750-1757</ispartof><rights>The Society for Surgery of the Alimentary Tract 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-e94144446c54caf33b6f15895a7ac991138fbc098677e0b9eadfa748760c02ba3</citedby><cites>FETCH-LOGICAL-c372t-e94144446c54caf33b6f15895a7ac991138fbc098677e0b9eadfa748760c02ba3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-012-1936-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-012-1936-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,781,785,27929,27930,41493,42562,51324</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22744637$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nisar, Pasha J.</creatorcontrib><creatorcontrib>Lavery, Ian C.</creatorcontrib><creatorcontrib>Kiran, Ravi P.</creatorcontrib><title>Influence of Neoadjuvant Radiotherapy on Anastomotic Leak After Restorative Resection for Rectal Cancer</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description><![CDATA[Purpose
This study was undertaken to determine whether neoadjuvant radiotherapy is associated with an increased risk of anastomotic leak for rectal cancer patients undergoing restorative resection.
Methods
From 1980 to 2010, patients who underwent restorative resection for rectal cancer (tumors within 15 cm of anal verge) were identified from a prospective institutional database and grouped based on whether they received neoadjuvant radiotherapy (+RT) or not (−RT). The main outcome was anastomotic leak documented by imaging (contrast leak), intra-operative or clinical (signs of peritonitis) findings and confirmed by staff surgeon assessment. Using multivariate (MV) analysis risk factors for leak were identified, presented as OR (95 % CI).
Results
One thousand eight hundred sixty-two patients were included in the analysis, 28 % in the +RT group. Eighty-six percent of +RT patients received neoadjuvant chemoradiotherapy. The overall leak rate was 6.3 %, with no significant difference in +RT and −RT groups (8 % vs 5.7 %,
p
= 0.06). The +RT group had a lower mean age at surgery (58 vs 63 year,
p
< 0.001), more male (75 % vs 62 %,
p
< 0.001) and more ASA 3/4 (44 % vs 35 %,
p
< 0.001) patients, greater use of defunctioning ostomy (87 % vs 44 %,
p
< 0.001) and colo-anal anastomosis (77 % vs 34 %,
p
< 0.001). Mean tumor distance from the anal verge was lower in +RT group (6.6 vs 9.7 cm,
p
< 0.001). On MV analysis, male sex (OR 1.64 (1.03–2.62),
p
= 0.038), ASA 4 (OR 4.70 (2.07–10.7),
p
< 0.001), tumor distance from anal verge ≤ 5 cm (OR 2.49 (1.37–4.52),
p
= 0.003), and tumor size at surgery ≥ 4 cm (OR 1.75 (1.15–2.65),
p
= 0.009) were independently associated with leak. +RT was not independently associated with leak (OR 1.44 (0.85–2.46),
p
= 0.18), while defunctioning ostomy did not reduce leak occurrence (OR 0.75 (0.44–1.28),
p
= 0.29).
Conclusions
The findings suggest that neoadjuvant radiotherapy is not independently associated with an anastomotic leak for rectal cancer patients undergoing restorative resection and support a selective policy towards the use of a defunctioning ostomy on a case by case basis based on intra-operative judgment and consideration of tumor location, size, and patient characteristics.]]></description><subject>Aged</subject><subject>Anastomotic Leak - etiology</subject><subject>Cancer surgery</subject><subject>Colectomy - adverse effects</subject><subject>Colorectal cancer</subject><subject>Colostomy</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neoadjuvant Therapy - adverse effects</subject><subject>Original Article</subject><subject>Ostomy</subject><subject>Patients</subject><subject>Quality of Life</subject><subject>Radiation therapy</subject><subject>Radiotherapy, Adjuvant - adverse effects</subject><subject>Rectal Neoplasms - radiotherapy</subject><subject>Rectal Neoplasms - surgery</subject><subject>Risk Factors</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgical anastomosis</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kMFqGzEQhkVISFI3D9BLEPS87Yx2Je0ejWlSg2nAtNCbmJUlZ1175Wq1Br99ZJyUXjKXGWa--Uf6GfuE8AUB9NcBUYEsAEWBTakKuGC3WOuyqJRQl7mGBgsh5e8b9mEYNgCoAetrdiOEripV6lu2nvd-O7reOh48_-ECrTbjgfrEl7TqQnp2kfZHHno-7WlIYRdSZ_nC0R8-9clFvnS5Gyl1B3eqnU1dhn04TWyiLZ9RFo8f2ZWn7eDuXvOE_Xr49nP2vVg8Pc5n00VhSy1S4ZoKqxzKysqSL8tWeZR1I0mTbRrEsvathaZWWjtoG0crT7qqtQILoqVywj6fdfcx_B3z28wmjLHPJw1KyL9GKUWm8EzZGIYhOm_2sdtRPBoEc7LWnK012VpzstZA3rl_VR7bnVv923jzMgPiDAx51K9d_O_0u6ovjD-ELQ</recordid><startdate>20120901</startdate><enddate>20120901</enddate><creator>Nisar, Pasha J.</creator><creator>Lavery, Ian C.</creator><creator>Kiran, Ravi P.</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope></search><sort><creationdate>20120901</creationdate><title>Influence of Neoadjuvant Radiotherapy on Anastomotic Leak After Restorative Resection for Rectal Cancer</title><author>Nisar, Pasha J. ; Lavery, Ian C. ; Kiran, Ravi P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-e94144446c54caf33b6f15895a7ac991138fbc098677e0b9eadfa748760c02ba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Anastomotic Leak - etiology</topic><topic>Cancer surgery</topic><topic>Colectomy - adverse effects</topic><topic>Colorectal cancer</topic><topic>Colostomy</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Neoadjuvant Therapy - adverse effects</topic><topic>Original Article</topic><topic>Ostomy</topic><topic>Patients</topic><topic>Quality of Life</topic><topic>Radiation therapy</topic><topic>Radiotherapy, Adjuvant - adverse effects</topic><topic>Rectal Neoplasms - radiotherapy</topic><topic>Rectal Neoplasms - surgery</topic><topic>Risk Factors</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgical anastomosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nisar, Pasha J.</creatorcontrib><creatorcontrib>Lavery, Ian C.</creatorcontrib><creatorcontrib>Kiran, Ravi P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nisar, Pasha J.</au><au>Lavery, Ian C.</au><au>Kiran, Ravi P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of Neoadjuvant Radiotherapy on Anastomotic Leak After Restorative Resection for Rectal Cancer</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2012-09-01</date><risdate>2012</risdate><volume>16</volume><issue>9</issue><spage>1750</spage><epage>1757</epage><pages>1750-1757</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract><![CDATA[Purpose
This study was undertaken to determine whether neoadjuvant radiotherapy is associated with an increased risk of anastomotic leak for rectal cancer patients undergoing restorative resection.
Methods
From 1980 to 2010, patients who underwent restorative resection for rectal cancer (tumors within 15 cm of anal verge) were identified from a prospective institutional database and grouped based on whether they received neoadjuvant radiotherapy (+RT) or not (−RT). The main outcome was anastomotic leak documented by imaging (contrast leak), intra-operative or clinical (signs of peritonitis) findings and confirmed by staff surgeon assessment. Using multivariate (MV) analysis risk factors for leak were identified, presented as OR (95 % CI).
Results
One thousand eight hundred sixty-two patients were included in the analysis, 28 % in the +RT group. Eighty-six percent of +RT patients received neoadjuvant chemoradiotherapy. The overall leak rate was 6.3 %, with no significant difference in +RT and −RT groups (8 % vs 5.7 %,
p
= 0.06). The +RT group had a lower mean age at surgery (58 vs 63 year,
p
< 0.001), more male (75 % vs 62 %,
p
< 0.001) and more ASA 3/4 (44 % vs 35 %,
p
< 0.001) patients, greater use of defunctioning ostomy (87 % vs 44 %,
p
< 0.001) and colo-anal anastomosis (77 % vs 34 %,
p
< 0.001). Mean tumor distance from the anal verge was lower in +RT group (6.6 vs 9.7 cm,
p
< 0.001). On MV analysis, male sex (OR 1.64 (1.03–2.62),
p
= 0.038), ASA 4 (OR 4.70 (2.07–10.7),
p
< 0.001), tumor distance from anal verge ≤ 5 cm (OR 2.49 (1.37–4.52),
p
= 0.003), and tumor size at surgery ≥ 4 cm (OR 1.75 (1.15–2.65),
p
= 0.009) were independently associated with leak. +RT was not independently associated with leak (OR 1.44 (0.85–2.46),
p
= 0.18), while defunctioning ostomy did not reduce leak occurrence (OR 0.75 (0.44–1.28),
p
= 0.29).
Conclusions
The findings suggest that neoadjuvant radiotherapy is not independently associated with an anastomotic leak for rectal cancer patients undergoing restorative resection and support a selective policy towards the use of a defunctioning ostomy on a case by case basis based on intra-operative judgment and consideration of tumor location, size, and patient characteristics.]]></abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>22744637</pmid><doi>10.1007/s11605-012-1936-0</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1091-255X |
| ispartof | Journal of gastrointestinal surgery, 2012-09, Vol.16 (9), p.1750-1757 |
| issn | 1091-255X 1873-4626 |
| language | eng |
| recordid | cdi_proquest_journals_1507441552 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Aged Anastomotic Leak - etiology Cancer surgery Colectomy - adverse effects Colorectal cancer Colostomy Female Gastroenterology Humans Male Medicine Medicine & Public Health Meta-analysis Middle Aged Mortality Neoadjuvant Therapy - adverse effects Original Article Ostomy Patients Quality of Life Radiation therapy Radiotherapy, Adjuvant - adverse effects Rectal Neoplasms - radiotherapy Rectal Neoplasms - surgery Risk Factors Surgeons Surgery Surgical anastomosis |
| title | Influence of Neoadjuvant Radiotherapy on Anastomotic Leak After Restorative Resection for Rectal Cancer |
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