Previous radiation for prostate neoplasm alters surgical and oncologic outcomes after rectal cancer surgery

Guandalino, M.; Dupré, Aurélien; François, Marie; Leroy, B.; Antomarchi, O.; Buc, Emmanuel; Dubois, Anne; Laurent, Césari; Pezet, Denis; Gagnière, Johan

doi:10.1002/jso.24075

Cited by 8 publications

(21 citation statements)

References 38 publications

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“…In our historical study [1], we showed 50% with anastomotic leakage and 50% with Dindo III-V complications. Guandalino et al [2] showed 62.5% with anastomotic leakage and 25% of with definitive stoma in eight patients with previous radiotherapy for prostate cancer. Lakkis et al [3], in a French multicentre retrospective study comparing patients treated for rectal cancer with and without previous curative treatment for prostate cancer, found major surgical morbidity (28% vs 17.2%), anastomotic leakage (25% vs 13.7%) and permanent stoma (41% vs 12.4%) more frequently in patients with a history of prostate cancer treated with high-dose radiotherapy, prostatectomy or brachytherapy.…”

Section: Discussionmentioning

confidence: 96%

Delayed coloanal anastomosis: an alternative option for restorative rectal cancer surgery after high‐dose pelvic radiotherapy for prostate cancer

et al. 2020

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Aim Restorative total mesorectal excision (TME) for rectal cancer after high-dose pelvic radiotherapy for prostate cancer has been reported to provide an unacceptable rate of pelvic sepsis. In a previous publication we proposed that delayed coloanal anastomosis (DCAA) should be performed in this situation. The present study aimed to assess the feasibility and outcomes of this strategy. Method Between 2000 and 2018, 1094 men were operated on for rectal cancer in our institution. All men with T2/T3 mid and low rectal cancer with preoperative radiotherapy and restorative TME were considered for this study (n = 416). Patients with external-beam high-dose radiotherapy (EBHRT) for prostate cancer (70-78 Gy) were identified and compared with patients with conventional long-course chemoradiotherapy (CRT) followed by TME. We compared our already published historical cohort (2000-2012), including arm A (CRT + TME; n = 236) and arm B (EBHRT + TME; n = 12), with our early cohort (2013-2018), including arm C (CRT + TME; n = 158) and arm D (EBHRT + TME-DCAA; n = 10). The end-points were morbidity, pelvic sepsis, reoperation rate and quality of the specimen. Results Overall morbidity was not significantly different between groups. Pelvic sepsis decreased from 50% (arm B) to 10% (arm D) with the use of DCAA (P = 0.074), and was similar between arms A, C and D. Quality of the specimen was not significantly different between the four groups. Conclusion Our results suggest that TME with DCAA in patients with previous EBHRT is feasible, with the same postoperative pelvic sepsis rate as conventional CRT.

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Section: Discussionmentioning

confidence: 96%

Delayed coloanal anastomosis: an alternative option for restorative rectal cancer surgery after high‐dose pelvic radiotherapy for prostate cancer

et al. 2020

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“…Small retrospective studies have suggested increased surgical morbidity in rectal cancer surgery following high‐dose RT. No association between previous prostate cancer treatment including prostatectomy and rectal cancer surgery outcomes has been reported.…”

Section: Introductionmentioning

confidence: 99%

Morbidity and oncological outcomes of rectal cancer impaired by previous prostate malignancy

Lakkis

Vernerey

Mège

et al. 2019

British Journal of Surgery

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Background Specific surgical and oncological outcomes in patients with rectal cancer surgery after a previous diagnosis of prostate cancer have not been well described. The aim of this study was to compare surgical outcomes in patients with rectal cancer with or without a history of prostate cancer. Methods Patients who had surgery for rectal cancer with (PC group) or without (no‐PC group) previous curative treatment for prostate cancer were enrolled between January 2001 and December 2015. Comparisons between the two groups were performed by multivariable Cox analysis, and after propensity score matching in a 3 : 1 ratio for demographic and tumour characteristics, and surgical and oncological outcomes. Results A total of 944 patients with rectal cancer were enrolled, of whom 10·8 per cent had a history of prostate cancer. After matching, 83 patients who had received treatment for prostate cancer were compared with 249 who had not. The PC and no‐PC groups were similar regarding patient characteristics. Extended total mesorectal excision, conversion to open surgery, transfusion and tumour perforation were more frequent in the PC group than in the no‐PC group. Major surgical morbidity (28 versus 17·2 per cent; P = 0·036), anastomotic leakage (25 versus 13·7 per cent; P = 0·019) and permanent stoma (41 versus 12·4 per cent; P < 0·001) occurred more frequently in the PC group. Local recurrence was increased significantly in the PC group (17 versus 8·0 per cent; P = 0·019), and resulted in a significant decrease in disease‐free and overall survival. Conclusion Prostate cancer treatment increases short‐ and long‐term surgical morbidity in patients with rectal cancer, and impairs oncological outcomes.

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“…After previous pelvic radiotherapy for PC, the management of colorectal tumours that would usually necessitate AR remains challenging for surgeons. Previous pelvic radiation increases the risk of intra-operative ureteric injury and post-operative anastomotic leak in AR [ 2 , 3 ]. Guandlaino et al showed that previous radiation for PC was associated with anastomotic leak rate of 62.5% compared to 12.5% in those who had not received such treatment [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Prostate and rectal cancers are the most common pelvic malignancies affecting the male population [ 1 , 2 ]. Given that 10% of men will develop prostate cancer (PC) and that external beam radiotherapy (EBRT) is commonly used for treatment, many patients diagnosed with rectal cancer will have already received radical radiotherapy, with significant implications for management [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Due to the anatomical proximity of the prostate and the rectum, EBRT results in difficulty in defining anatomy and mobilising the mesorectum in anterior resection (AR) due to pelvic fibrosis [ 2 ]. Ureteric injuries are more common as a result of pelvic fibrosis compromising ureteric identification and It is associated with a significant increase in anastomotic leakage, with a rate as high as 62.5% [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Technical challenges and potential solutions for rectal and sigmoid tumours following previous radiation for prostate malignancy: A case series

Hannan

Ryan

Toomey

2020

International Journal of Surgery Case Reports

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Highlights Anterior resection following pelvic irradiation is highly challenging. Non-restorative procedures allow a high-risk anastomosis to be avoided. Transanal minimally invasive surgery is useful for early cancer and benign polyps. Segmental wedge resection may be beneficial in select cases. Tailoring and individualising treatment is essential to improve outcomes.

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Previous radiation for prostate neoplasm alters surgical and oncologic outcomes after rectal cancer surgery

Cited by 8 publications

References 38 publications

Delayed coloanal anastomosis: an alternative option for restorative rectal cancer surgery after high‐dose pelvic radiotherapy for prostate cancer

Delayed coloanal anastomosis: an alternative option for restorative rectal cancer surgery after high‐dose pelvic radiotherapy for prostate cancer

Morbidity and oncological outcomes of rectal cancer impaired by previous prostate malignancy

Technical challenges and potential solutions for rectal and sigmoid tumours following previous radiation for prostate malignancy: A case series

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