The effect of time interval from chemoradiation to surgery on postoperative complications in patients with rectal cancer

Alice M Couwenberg; Martijn P W Intven; Sieske Hoendervangers; Frederik J van der Sluis; Henderik L van Westreenen; Corrie A M Marijnen; Wilhelmina M U van Grevenstein; Helena M Verkooijen; Dutch ColoRectal Audit

doi:10.1016/j.ejso.2019.04.016

The effect of time interval from chemoradiation to surgery on postoperative complications in patients with rectal cancer

Eur J Surg Oncol. 2019 Sep;45(9):1584-1591. doi: 10.1016/j.ejso.2019.04.016. Epub 2019 Apr 25.

Authors

Alice M Couwenberg¹, Martijn P W Intven², Sieske Hoendervangers², Frederik J van der Sluis³, Henderik L van Westreenen³, Corrie A M Marijnen⁴, Wilhelmina M U van Grevenstein⁵, Helena M Verkooijen⁶; Dutch ColoRectal Audit

Affiliations

¹ Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX Utrecht, the Netherlands. Electronic address: a.m.couwenberg@umcutrecht.nl.
² Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX Utrecht, the Netherlands.
³ Department of Surgery, Isala Clinics, Dokter van Heesweg 2, 8025, AB Zwolle, the Netherlands.
⁴ Department of Radiation Oncology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA Leiden, the Netherlands.
⁵ Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX Utrecht, the Netherlands.
⁶ Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX Utrecht, the Netherlands; University of Utrecht, Utrecht, the Netherlands.

PMID: 31053479
DOI: 10.1016/j.ejso.2019.04.016

Abstract

Background: A prolonged time interval between chemoradiation and total mesorectal excision (TME) may render more rectal cancer patients eligible for organ-sparing approaches but may also cause more pelvic fibrosis and surgical morbidity. We estimated the effect of time interval on postoperative complications and other surgical outcomes in rectal cancer patients.

Methods: This is a population-based cohort study using data of the Dutch Colorectal Audit. Rectal cancer patients treated with chemoradiation followed by TME after an interval of 3-20 weeks were selected (n = 6,268). Time interval from completion of chemoradiation to TME was categorized into 3-6, 7-8, 9-10, 11-12 and 13-20 weeks. Outcomes included postoperative complication (any, and stratified by medical and surgical complications), reintervention, intraoperative complication, incomplete resection, positive circumferential margin (CRM) and pathological complete response (pCR). The interval of 7-8 weeks was the reference group.

Results: Prolonged time intervals were not associated with a higher risk of a postoperative complication (any, surgical or medical), reintervention, and incomplete resection. Intraoperative complications were however more common after 11-12 weeks than after 7-8 weeks (odds ratio (OR) = 1.79, 95% confidence interval (CI) = 1.20-2.69). The interval of 9-10 weeks was associated with less CRM positive resections, and 9-10 and 13-20 weeks with more pCR (relative to 7-8 weeks, OR = 0.74, 95%CI = 0.56-0.98; OR = 1.28, 95%CI = 1.04-1.58; and OR = 1.33, 95%CI = 1.04-1.71, respectively).

Conclusions: Compared with 7-8 weeks, longer time intervals up to 13-20 weeks between chemoradiation and TME are not associated with more postoperative complications or more positive resection margins. Accordingly, prolonging the interval aiming for organ-sparing treatment is safe.

Keywords: Postoperative complications; Radiotherapy; Rectal cancer; Risk; Surgery; Time interval.

MeSH terms

Aged
Chemoradiotherapy*
Female
Humans
Male
Middle Aged
Netherlands / epidemiology
Organ Sparing Treatments
Postoperative Complications / epidemiology*
Rectal Neoplasms / surgery
Rectal Neoplasms / therapy*
Time-to-Treatment*