Effect of neoadjuvant therapy on early postoperative complications in rectal cancer

Abstract

Introduction: The treatment of locally advanced rectal cancer is multimodal. It includes neoadjuvant chemoradiotherapy (NCHRT). NCHRT has been shown to reduce the risk of local recurrence. New treatment regimens also have a positive impact on patient survival. NCHRT leads to fibrotic changes in the pelvis and is associated with side effects. NCHRT may have a negative impact on postoperative complications. The aim of this study was to demonstrate whether NCHRT increases the number of early postoperative complications.
Methods: An analysis of our own cohort of 200 patients with rectal cancer undergoing robotic-assisted surgery between 2018 and 2022 was performed. The cohort was divided into patients who underwent NCHRT and subsequently surgery and patients who underwent primary surgery. The two groups were compared in terms of duration of surgery, blood loss, incidence of anastomotic complications, and quality of mesorectal excision.
Results: Patients who underwent NCHRT had a longer operation time, by 34 minutes on average. We did not demonstrate a higher incidence of anastomotic complications in these patients. Patients who underwent primary surgery had a slightly lower blood loss and better quality of mesorectal excision during surgery. Nevertheless, complete or nearly complete mesorectal anastomosis was achieved in more than 85% of cases in both groups.
Conclusion: Radiotherapy results in postradiation changes in the lesser pelvis. These changes impair visibility and dissection during surgery. Operations after NCHRT are more technically demanding and take longer but do not have more anastomotic complications. Also, the quality of mesorectal excision is satisfactory in both groups.