The Effect of Interval From Completion of Short-Course Radiotherapy to Surgery on the Post-Operative Morbidity and Mortality of Patients with Rectal Cancer

Aim: Surgery is the mainstay of treatment for invasive rectal cancer. Advances in surgical technique and radiotherapy over the past few decades have resulted in improved local control and survival.1-3 Some concern remains regarding the morbidity associated with performing surgery within a short window following radiotherapy. The current study assessed whether the interval between short-course radiotherapy and surgery influences all cause post-operative morbidity and mortality. Methods: All patients who had undergone short-course radiotherapy for rectal cancer within the Belfast Health and Social Care Trust from 2005 to 2014 held on a prospective database were included (n=102). A retrospective review of patients’ clinical records was performed and a comparison made of patients who had undergone surgery less than 4 days with those 4 or more days following completion of radiotherapy. Baseline patient and tumour characteristics, post-operative complications and readmission rates were compared. Statistical analysis was performed using SPSS ®, Version 22 (SPSS, Inc, Chicago, Illinois, USA). Results: There was no significant difference in mortality or overall post-operative complications between groups, however, less serious complications were reduced in patients undergoing surgery less than 4 days following radiotherapy. Perineal wound complications were significantly more common in patients who had undergone surgery 4 or more days following radiotherapy. Conclusion: Our results support the existing data that post-operative complications may be more common with increasing interval to surgery from completion of radiotherapy. Perineal wound morbidity appears significantly more common in patients who undergo surgery 4 or more days following short-course radiotherapy. A larger study to look particularly at perineal wound morbidity and interval from completion of radiotherapy is warranted.