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SURGICAL
COMPLICATIONS AFTER PREOPERATIVE RADIOTHERAPY FOR LOCALLY ADVANCED
RECTAL CANCER
Petroviæ
T, Breberina M, Radovanoviæ Z, Bokorov B, Muzikraviæ Lj, Maniæ
D, Patrnogiæ A, Guduriæ B.
Institute
of Oncology Sremska Kamenica, Sremska Kamenica, Serbia and Montenegro
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ABSTRACT
Many
studies confirmed that preoperative radiotherapy in locally advanced
rectal cancer leads to tumor downstaging and enhanced resectability
rate. This article analyses possible complications of this combined
modality. Patients were enrolled between June 2000 and July 2003.
To be eligible, patients had to have histologically proven rectal
carcinoma (up to 12 cm from anal verge), locally advanced (T3 or
T4 stage) mz pelvic magnetic resonance scan and without evidence
of distant metastases. Forty-one patients (28 male and 13 female)
with median age of 63 (ranging from 42 to 77) received preoperative
radiotherapy (two fields technique AP/PA, 50 Gy, daily fraction
2 Gy) followed by surgery after six weeks. In 6 patients (14.6%)
only palliative operation was performed (permanent colostomy) due
to disease progression (in two cases distant metastases and in four
patients local progression). Radical surgery was performed in 35
(85.4%) patients. Average distance of the tumor from anal verge
was 4.8 cm. Low anterior resection was performed in 18 cases and
abdominoperineal resection in 17 patients. One patient died during
the perioperative period due to complications of jejunostomy and
peritonitis. One patient died due to vast postirradiation enteritis
27 months after radical operation. Four patients (11.4 %) developed
local recurrence (all after Miles operation) after 19 months (median
time of follow up) and all of them were again irradiated. In two
patients rectovaginal fistula appeared after 6 and 8 months after
radical operation and colostomy had to be performed. Two men (out
of 20 radically operated) became impotent and two women (out of
14) had sexual dysfunction during intercourse. Two patients had
peristomal hernias and two patients were incontinent for gas and
liquid stool. There are many potential advantages of preoperative
radiation therapy in rectal cancer treatment although possible complications
have to be considered. |
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Keywords:
Rectal cancer, Preoperative radiotherapy, Complications, Surgery |
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