Post-surgery anastomotic leakage and stenosis is associated with pre-surgery radiation therapy

This study investigated the impact of radiation therapy (RT) followed by surgery in rectal cancer patients. Researchers suggested that RT increases the risk of anastomotic leakage and narrowing (stenosis) after rectal cancer.

Surgery for rectal cancer often involves the rejoining of two parts of intestine. Anastomotic leakage (AL) consists of escape of intestinal liquids from the surgery site after rectal surgery. The incidence of AL after rectal cancer surgery is between 3-12%. This post-surgery complication is associated with increased mortality after surgery as well as poor cancer outcomes. Anastomotic stenosis (AS) leads to difficult evacuation or obstruction of the bowel.

Pre-surgery chemotherapy and RT is the standard treatment for locally advanced rectal cancer. However, there is evidence that pre-surgery RT might be associated with AL and AS.  

The objective of this study was to investigate the impact of pre-surgery RT on AL and AS after rectal cancer surgery.

This study included 318 patients with stage 2 and stage 3 rectal operable rectal cancers. Patients were randomly assigned to receive pre-surgery chemotherapy and RT (200 patients) or chemotherapy alone (118 patients)

The total rate of AL was 17%. AL occurred more commonly in patients treated with RT than in those treated with chemotherapy alone. The total rate of AS was 13.8%. AS also occured more often in patients treated with RT.

Among the 54 patients with AL, 7 underwent further surgery to repair the leakage. No further surgery was needed for patients who received chemotherapy alone. Among the 44 patients with AS, 11 underwent further surgery.

Patients who received pre-surgery RT were 3.5 times more at risk of experiencing AL. Patients with post-surgery AL were 14.96 times more at risk of developing AS. 

This study showed an association between pre-surgery RT and anastomotic leakage and stenosis.