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.