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Anastomotic leakage after anterior resection in patients with rectal cancer previously irradiated for prostate cancer
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.ORCID iD: 0000-0001-5448-0888
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Urology.ORCID iD: 0000-0002-8306-0687
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: There are little data on the post-operative outcome of anterior resection (AR) for rectal cancer in men who had received radiotherapy for prostate cancer previously. The aim of this study was to assess the rate of anastomotic leakage (AL) after AR in these patients.

Methods: All men who underwent bowel resection because of rectal cancer between 2000 and 2016 and had been diagnosed previously with prostate cancer were identified by linking the Swedish Colorectal Cancer Registry with the National Prostate Cancer Register. The medical records of men who underwent AR and had previously received radiotherapy for prostate cancer were reviewed.

Results: In total, 13299 men had undergone a bowel resection for rectal cancer, 188 of whom had previously received radiotherapy for prostate cancer. Among those who had received radiation therapy, 59 men (31%) had an AR: 50 men (85%) received a diverting ileostomy, 42 men (71%) had an American Society of Anesthesiologists score of 1–2 and 36 men (61%) had tumour stage 1–2. AL was found in 12/59 men (20%), one of whom had a re-laparotomy. There was no 90-day mortality.

Conclusions: In the combined national population-based registries, a minority of patients with rectal cancer had an AR after previous radiotherapy for prostate cancer. These patients were healthy with early cancer stages and, in this selected group of patients, the AL rate was much lower than that reported previously.

Keywords [en]
Rectal cancer, Prostate cancer, Complications, Anastomotic leakage, Radiation therapy
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-362617OAI: oai:DiVA.org:uu-362617DiVA, id: diva2:1254188
Available from: 2018-10-08 Created: 2018-10-08 Last updated: 2018-10-08
In thesis
1. Rectal cancer: Aspects of post-operative complications
Open this publication in new window or tab >>Rectal cancer: Aspects of post-operative complications
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to study post-operative complications in patients with rectal cancer.

Methods: Post-operative complications in patients operated for rectal cancer was retrospectively analyzed in three prospective registers; the local rectal cancer registry in the Västmanland County, Sweden, the Swedish Colorectal Cancer Registry (SCRCR) and the National Prostate Cancer Registry (NPCR). In Papers I and II, the focus was on the complication pattern after Hartmann’s procedure (HP). In Paper III, the incidence of parastomal hernia was assessed during a period when no prophylactic mesh was used (1996-2006) compared with a period when a prophylactic mesh was routinely used (2007-2012). In Paper IV, the anastomotic leakage (AL) rate after anterior resection (AR) for rectal cancer patients who had previously received RT for prostate cancer was assessed with combined data from the SCRCR and the NPCR.

Results: In Paper I, patients operated with a HP were significantly older, had a higher ASA-score, a poorer WHO performance score and lower serum albumin levels. Few developed pelvic complications. In Paper II, the intra-abdominal infection rate was 8% and the re-laparotomy rate was 10%. Multi-variable logistic regression analysis identified pre-operative radiotherapy as a risk factor for intra-abdominal infections. In Paper III, we found no difference in the rate of parastomal hernia between patients with and without a prophylactic stoma mesh. In Paper IV, we identified 59 out of 188 patients who had undergone previous radiation therapy for prostate cancer who had been operated with AR. Twelve (20%) developed an AL, of whom only one underwent re-laparotomy and there was no 90-day mortality.

Conclusion: The rate of serious post-operative complications was low after HP and it seems to be a safe and appropriate alternative in old and frail patients. Pre-operative radiotherapy was a risk factor for intra-abdominal infections in rectal cancer patients operated with a HP. A prophylactic stoma mesh did not reduce the rate of parastomal hernias. In patients that had previously been irradiated for prostate cancer, a minority underwent an AR. These patients were healthy with early cancer stages and, in this selected group of patients, the AL rate was much lower than previously reported.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 59
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1505
Keywords
Rectal cancer, Complications, Anastomotic leakage, Abscess, Parastomal hernia, Prostate cancer, Radiation therapy
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-362704 (URN)978-91-513-0469-4 (ISBN)
Public defence
2018-11-29, Aulan, entrance 21, Västmanlands Hospital, Västerås, Västerås, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-11-06 Created: 2018-10-08 Last updated: 2018-11-19

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Chabok, AbbasStattin, PärSmedh, KennetNikberg, Maziar

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