Impact of Neoadjuvant Radiotherapy on Complications After Hartmann Procedure for Rectal Cancer. Issue 10 (October 2015)

• Record Type: Journal Article
• Authors: Jonker, Frederik H. W.; Tanis, Pieter J.; Coene, Peter-Paul L. O.; van der Harst, Erwin
• Is Part Of: Diseases of the colon & rectum. Volume 58:Issue 10(2015:Oct.)
• Publication Date: 2015-10
• Subjects: Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; Colonic Diseases -- Periodicals; Colorectal Surgery -- Periodicals; 616.34
• DOI: 10.1097/DCR.0000000000000432
• Languages: English
• ISSNs: 0012-3706

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>BACKGROUND:</title> <p>The effects of neoadjuvant radiotherapy on healing of the rectal stump after a Hartmann procedure for rectal cancer are unknown.</p> </sec> <sec> <title>OBJECTIVE:</title> <p>The purpose of this study was to analyze the impact of radiotherapy on postoperative complications after a Hartmann procedure for rectal cancer at a population level.</p> </sec> <sec> <title>DESIGN:</title> <p>This was a population-based observational study. Postoperative outcomes were compared between Hartmann procedures with and without radiotherapy. Risk factors for postoperative intra-abdominal abscess requiring reintervention, any reintervention, and 30-day or in-hospital mortality were analyzed using a multivariable model.</p> </sec> <sec> <title>SETTINGS:</title> <p>The study included in-hospital registration for the Dutch Surgical Colorectal Audit.</p> </sec> <sec> <title>PATIENTS:</title> <p>Patients with rectal cancer who underwent a Hartmann procedure (total or partial mesorectal excision with end colostomy) between 2009 and 2013 were included.</p> </sec> <sec> <title>MAIN OUTCOME MEASURES:</title> <p>Abdominal abscess requiring reintervention, any reintervention, and 30-day or in-hospital mortality were measured.</p> </sec> <sec> <title>RESULTS:</title> <p>Of 1728 patients who underwent a Hartmann procedure for rectal cancer, 90.5% (n = 1563) received preoperative radiotherapy. Intra-abdominal abscess formation was significantly increased after radiotherapy (7.0% vs 3.0%; <italic>p</italic> = 0.049). Overall reinterventions (15.2% vs 15.4%; <italic>p</italic> = 0.90) and 30-day mortality (2.4% vs 3.5%; <italic>p</italic> = 0.48) were not associated with radiotherapy in univariable analysis. In multivariable analysis, radiotherapy was an independent predictor of postoperative intra-abdominal abscess requiring reintervention (OR, 2.81 (95% CI, 1.01–7.78)) but was not associated with overall reinterventions or mortality.</p> </sec> <sec> <title>LIMITATIONS:</title> <p>This study was limited by the data being self-reported. Case-mix adjustment was limited to information available in the data set, and no long-term outcome data were available.</p> </sec> <sec> <title>CONCLUSIONS:</title> <p>Based on these population-based data, radiotherapy is independently associated with an increased risk of postoperative intra-abdominal abscess requiring reintervention after Hartmann procedure for rectal cancer. This finding is relevant for patient-tailored postoperative care but should probably not influence indication for radiotherapy, because it did not affect overall reinterventions and mortality (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A193).</p> </sec> </abstract>