Short-term preoperative radiotherapy is a safe approach for treatment of locally advanced rectal cancer

BACKGROUND AND AIMS

The Swedish Rectal Cancer Trial (SRCT) demonstrated that a short term regimen of high-dose preoperative radiotherapy (5x5 Gy) not only reduces the risk of local recurrence but also improves overall survival rate. An increase in postoperative mortality and morbidity has also been observed, however. We therefore evaluated early postoperative complications in patients treated with neoadjuvant radiotherapy for locally advanced rectal adenocarcinoma.

PATIENTS/METHODS

Between 2000 and 2004, 85 patients with locally advanced rectal tumors were treated in our institution. Preoperative staging was based on CT scan and, in several cases, on endorectal ultrasonography. They were 55 men and 30 women, with a median age of 68 years. They were retrospectively divided into two groups: Group A, which included 40 patients undergoing preoperative radiotherapy (25 Gy in five fractions) followed by surgery within 1 week, and Group B, which included 45 patients with rectal cancer receiving surgery immediately after diagnosis. Both groups were homogeneous regarding age, gender and preoperative stage of the disease. The two groups were compared for both technical difficulties during operation and rate of postoperative complications.

RESULTS/FINDINGS

No postoperative deaths were recorded in either group. Low anterior resection with total mesorectal excision was performed in all group A patients, whereas eight patients in group B underwent abdominoperineal resection (P<0.05). Diverting stoma was performed in seven patients of group A and it was closed 3-6 months later on every occasion. Postoperative morbidity was not statistically significant between the two groups (40 vs 39%). The rate of postoperative hemorrhage, pelvic or abdominal wound infection, acute urinary infection, and delayed ileus was similar. The percentage of major anastomotic leak was also equivalent (5 vs 6.6%).

INTERPRETATION/CONCLUSION

Short-term preoperative radiotherapy does not increase the rate of postoperative complications and is a safe therapeutic adjunct for the treatment of locally advanced rectal cancer.

Mucocele of the appendiceal stump due to benign mucinous cystadenoma

Mucocele of the appendix is a rare lesion, characterized by distension of the lumen due to accumulation of mucus material. Correct preoperative diagnosis is seldom achieved. If left untreated, the mucocele may rupture producing a potentially fatal peritoneal spread. The type of surgical treatment is related to the dimensions and histology of the mucocele. In this paper, the case of a 49-year-old woman, with a previous appendectomy, suffering from a painful mass in the right lower quadrant of the abdomen, is reported. Imaging showed a large, cystic structure at the base of the cecum. Surgery revealed a 8x5.5 cm calcified tumor, which was excided together with the appendiceal remnant. Pathological diagnosis was that of a mucocele arising from the appendiceal stump due to the development of a benign mucinous cystadenoma.

Short-term preoperative radiotherapy in locally advanced rectal cancer does not increase postoperative complications and improves the rate of sphincter-preserving surgery

PURPOSE

The Swedish Rectal Cancer Trial (SRCT) demonstrated that a short term regimen of high-dose preoperative radiotherapy (RT) (5x5 Gy) not only reduces the risk for local recurrence, but also improves the overall survival rate. However, an increase in postoperative mortality and morbidity has also been observed. We, therefore, evaluated the early postoperative complications in patients treated with neoadjuvant RT for locally advanced rectal adenocarcinoma.

PATIENTS AND METHODS

Between 2000 and 2004, 85 patients with locally advanced rectal tumors were treated in our institution. Preoperative staging was based on computed tomography (CT) scan and, in several cases, with endorectal ultrasonography. There were 55 men and 30 women, with a median age of 68 years. Patients were retrospectively divided into two groups: group A, which included 40 patients receiving preoperative RT (25 Gy in 5 fractions), followed by surgery within one week, and group B, which included 45 patients with rectal cancer undergoing surgery immediately after diagnosis. Both groups were homogeneous regarding age, gender and preoperative stage of disease. The two groups were compared for both technical difficulties during operation and rate of postoperative complications.

RESULTS

No postoperative deaths were recorded in either group. In group A, complete pathologic response was observed in 6 (15%) patients and microscopic residual cancer was found in 8 (20%). Low anterior resection (LAR) with total mesorectal excision (TME) was performed in all group A patients, whereas 8 patients in group B underwent abdominoperineal resection (APR) (p < 0.05). Diverting stoma was performed in 7 patients of group A; this was closed 3-6 months later in all cases. Postoperative morbidity was not statistically significant between the two groups (40% versus 39%). The rate of postoperative hemorrhage, pelvic or abdominal wound infection, acute urinary infection and delayed ileus was similar. The percentage of major anastomotic leak was also similar in both groups (5 versus 6.6%).

CONCLUSION

Short-term preoperative RT in locally advanced rectal cancer does not increase postoperative complications and improves the rate of sphincter-preserving surgery.