The effect of neoadjuvant treatment on postoperative morbidity in upper rectal cancer

Background. The need of neoadjuvant treatment for upper rectal cancer remains the object of discussion, which makes further study of this topic important.

Аim. To estimate the postoperative complications rate depending on the type of neoajuvant treatment.

Materials and methods. A retrospective cohort multicenter study, that analyzed data of medical records of patients with upper rectal cancer from the archive of N.N. Blokhin Cancer Research Center of the ministry of Health of Russia, Ryzhikh national medical Research Center of Coloproctology of the ministry of Health of Russia and Stavropol Regional Clinical Oncology Center for 2007–2020. Patients were devided into 3 groups: the group of radiotherapy (5*5 gy), the group of neoadjuvant chemotherapy (4 courses of XELOX before surgery) and the group of surgery. The main endpoint was the study of anastomotic leak rate. Also we estimated the postoperative complications rate III–Iv degree (Clavien– Dindo), the sphincter-preserving surgery rate, the stoma creation rate, the postoperative mortality.

Results. we included 110 patients in radiotherapy group, 188 patients in neoadjuvant chemotherapy group, 103 patients in surgery group. Study groups were comparable by sex, ASA status and histological grade. Postoperative grade III– Iv complications (in all cases were associated with anastomotic leak) developed in 8 (6.8 %) patients in neoadjuvant chemotherapy group versus 11 (10.0 %) patients in radiotherapy group (p = 0.379) and 12 (11.7 %) patients in surgery group (p = 0.208). There weren»t any significant differences in this parameter between the radiotherapy and the surgery group (p = 0.698). R0-resection was performed in 117 (99.2 %) patients in neoadjuvant chemotherapy group versus 107 (97.3 %) patients in radiotherapy group (p = 0.280) and 103 patients (100 %) in surgery group (p = 0.349). Radiotherapy and surgery groups didn’t differ significantly in R0-resection rate (p = 0.091). 1 patient (0.84 %) in neoadjuvant chemotherapy died before surgery, in other groups there weren’t any lethal outcomes (p = 0.283). Only the male sex, had a statistically significant effect on the anastomotic leak rate (risk ratio (HR) 2.875; 95 % confidence interval (CI) 1.24–6.63; p = 0.003).

Conclusions. A study of these case histories of patients with cancer of the upper ampullary rectum, conducted by us, showed that neoadjuvant treatment didn»t affect the postoperative complications rate.

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