Publication:

Impact of neoadjuvant chemoradiotherapy on post-operative outcome in patients with rectal cancer

Background Neoadjuvant chemoradiotherapy not only helps in downstaging the rectal cancer, it also reduces the rate of local recurrence but it has its own attendant risk factors. Our aim is to look into the implications of neoadjuvant chemoradiotherapy in patients with rectal cancer in our hospital.

Methods Retrospective data was collected from the infoflex system of database for the patients who underwent neoadjuvant chemoradiotherapy between January 2016-December 2019 in our DGH. The data was analysed for demographics, type of surgery, histology, length of stay, complications and stoma reversal rates.

Results Total 27 patients with rectal cancer during the study period underwent neoadjuvant chemoradiotherapy. 16 were male and 11 females. Age range was 33-82 year. 13 patients underwent APER, 8 Hartmann’s and 6 anterior resection with covering loop ileostomy. 5 patients initially required defunctioning sigmoid loop colostomy and one loop ileostomy prior to the start of neoadjuvant treatment. Histology showed 26 adenocarcinoma, and 1 squamous cell cancer. 3 patients had complete pathological response (cPR). Post-operative stay was from 5-32 days. 12 patients developed pelvic collection, 5 wound infection (4 perineal+1 abdominal), 5 had paralytic ileus, 1 patient had PR bleed, 2 anastomotic leak and 2 patients had chest related complications. Only 4 out of 6 loop ileostomies were reversed.

Conclusions Neoadjuvant treatment benefits come with its attendant complications. The tissue response to radiotherapy and chemotherapy and advanced tumor stage may contribute for the increased morbidity. Hopefully in future with the advent of new armamentarium, the degree of morbidity may come down.