Safety and efficacy of low anterior resection for rectal cancer

681 Consecutive cases from a specialty service

Warren E. Enker, Nipun Merchant, Alfred M. Cohen, Nicole M. Lanouette, Carol Swallow, Jose Guillem, Philip Paty, Bruce Minsky, Katherine Weyrauch, Stuart H Q Quan

Research output: Contribution to journalArticle

253 Citations (Scopus)

Abstract

Objective: To determine perioperative morbidity, survival, and local failure rates in a large group of consecutive patients with rectal cancer undergoing low anterior resection by multiple surgeons on a specialty service. The primary objective was to assess the surgical complications associated with preoperative radiation sequencing. Summary Background Data: The goals in the treatment of rectal cancer are cure, local control, and preservation of sphincter, sexual, and bladder function. Surgical resection using sharp perimesorectal dissection is important for achieving these goals. The complications and mortality rate of this surgical strategy, particularly in the setting of preoperative chemoradiation, have not been well defined. Methods: There were 1233 patients with primary rectal cancer treated at the authors' cancer center from 1987 to 1995. Of these, 681 underwent low anterior resection and/or coloanal anastomosis for primary rectal cancer. The surgical technique used the principles of sharp perimesorectal excision. Morbidity and mortality rates were compared between patients receiving preoperative chemoradiation (Preop RT, n = 150) and those not receiving preoperative chemoradiation (No Preop RT, n = 531). Recurrence and survival data were determined in patients undergoing curative resection (n = 583, 86%) among three groups of patients: those receiving Preop RT (n = 131), those receiving postoperative chemoradiation (Postop RT, n = 110), and those receiving no radiation therapy (No RT, n = 342). Results: The perioperative mortality rate was 0.6% (4/681). Postoperative complications occurred in 22% (153/681). The operative time, estimated blood loss, and rate of pelvic abscess formation without associated leak were higher in the Preop RT group than the No Preop RT group. However, the overall complication rate, rate of wound infection, anastomotic leak, and length of hospital stay were no different between Preop RT and No Preop RT patients. With a median follow-up of 45.6 months, the overall actuarial 5-year recurrence rate for patients undergoing curative resection (n = 583) was 19%, with 4% having local recurrence only, 12% having distant recurrence, and 3% having both local and distant recurrence, for an overall local recurrence rate of 7%. The actuarial 5-year overall survival rate was 81%; the disease-free survival rate was 75% and the local recurrence rate was 10%. The overall survival rate was similar between Preop RT (85%), Postop RT (72%), and No RT (83%) patients (p = 0.10), whereas the disease-free survival rate was significantly worse for Postop RT (65%) patients compared with Preop RT (79%) and No RT (77%) patients (p = 0.04). Conclusion: The use of preoperative chemoradiation results in increased operative time, blood loss, and pelvic abscess formation but does not increase the rate of anastomotic leaks or the length of hospital stay after low anterior resection for rectal cancer. The 5-year actuarial overall survival rate for patients undergoing curative resection exceeded 80%, with a local recurrence rate of 10%.

Original languageEnglish (US)
Pages (from-to)544-554
Number of pages11
JournalAnnals of Surgery
Volume230
Issue number4
DOIs
StatePublished - Oct 1999
Externally publishedYes

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Rectal Neoplasms
Safety
Recurrence
Survival Rate
Length of Stay
Anastomotic Leak
Operative Time
Abscess
Disease-Free Survival
Mortality
Morbidity
Survival
Wound Infection
Dissection
Urinary Bladder
Radiotherapy
Radiation

ASJC Scopus subject areas

  • Surgery

Cite this

Safety and efficacy of low anterior resection for rectal cancer : 681 Consecutive cases from a specialty service. / Enker, Warren E.; Merchant, Nipun; Cohen, Alfred M.; Lanouette, Nicole M.; Swallow, Carol; Guillem, Jose; Paty, Philip; Minsky, Bruce; Weyrauch, Katherine; Quan, Stuart H Q.

In: Annals of Surgery, Vol. 230, No. 4, 10.1999, p. 544-554.

Research output: Contribution to journalArticle

Enker, WE, Merchant, N, Cohen, AM, Lanouette, NM, Swallow, C, Guillem, J, Paty, P, Minsky, B, Weyrauch, K & Quan, SHQ 1999, 'Safety and efficacy of low anterior resection for rectal cancer: 681 Consecutive cases from a specialty service', Annals of Surgery, vol. 230, no. 4, pp. 544-554. https://doi.org/10.1097/00000658-199910000-00010
Enker, Warren E. ; Merchant, Nipun ; Cohen, Alfred M. ; Lanouette, Nicole M. ; Swallow, Carol ; Guillem, Jose ; Paty, Philip ; Minsky, Bruce ; Weyrauch, Katherine ; Quan, Stuart H Q. / Safety and efficacy of low anterior resection for rectal cancer : 681 Consecutive cases from a specialty service. In: Annals of Surgery. 1999 ; Vol. 230, No. 4. pp. 544-554.
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abstract = "Objective: To determine perioperative morbidity, survival, and local failure rates in a large group of consecutive patients with rectal cancer undergoing low anterior resection by multiple surgeons on a specialty service. The primary objective was to assess the surgical complications associated with preoperative radiation sequencing. Summary Background Data: The goals in the treatment of rectal cancer are cure, local control, and preservation of sphincter, sexual, and bladder function. Surgical resection using sharp perimesorectal dissection is important for achieving these goals. The complications and mortality rate of this surgical strategy, particularly in the setting of preoperative chemoradiation, have not been well defined. Methods: There were 1233 patients with primary rectal cancer treated at the authors' cancer center from 1987 to 1995. Of these, 681 underwent low anterior resection and/or coloanal anastomosis for primary rectal cancer. The surgical technique used the principles of sharp perimesorectal excision. Morbidity and mortality rates were compared between patients receiving preoperative chemoradiation (Preop RT, n = 150) and those not receiving preoperative chemoradiation (No Preop RT, n = 531). Recurrence and survival data were determined in patients undergoing curative resection (n = 583, 86{\%}) among three groups of patients: those receiving Preop RT (n = 131), those receiving postoperative chemoradiation (Postop RT, n = 110), and those receiving no radiation therapy (No RT, n = 342). Results: The perioperative mortality rate was 0.6{\%} (4/681). Postoperative complications occurred in 22{\%} (153/681). The operative time, estimated blood loss, and rate of pelvic abscess formation without associated leak were higher in the Preop RT group than the No Preop RT group. However, the overall complication rate, rate of wound infection, anastomotic leak, and length of hospital stay were no different between Preop RT and No Preop RT patients. With a median follow-up of 45.6 months, the overall actuarial 5-year recurrence rate for patients undergoing curative resection (n = 583) was 19{\%}, with 4{\%} having local recurrence only, 12{\%} having distant recurrence, and 3{\%} having both local and distant recurrence, for an overall local recurrence rate of 7{\%}. The actuarial 5-year overall survival rate was 81{\%}; the disease-free survival rate was 75{\%} and the local recurrence rate was 10{\%}. The overall survival rate was similar between Preop RT (85{\%}), Postop RT (72{\%}), and No RT (83{\%}) patients (p = 0.10), whereas the disease-free survival rate was significantly worse for Postop RT (65{\%}) patients compared with Preop RT (79{\%}) and No RT (77{\%}) patients (p = 0.04). Conclusion: The use of preoperative chemoradiation results in increased operative time, blood loss, and pelvic abscess formation but does not increase the rate of anastomotic leaks or the length of hospital stay after low anterior resection for rectal cancer. The 5-year actuarial overall survival rate for patients undergoing curative resection exceeded 80{\%}, with a local recurrence rate of 10{\%}.",
author = "Enker, {Warren E.} and Nipun Merchant and Cohen, {Alfred M.} and Lanouette, {Nicole M.} and Carol Swallow and Jose Guillem and Philip Paty and Bruce Minsky and Katherine Weyrauch and Quan, {Stuart H Q}",
year = "1999",
month = "10",
doi = "10.1097/00000658-199910000-00010",
language = "English (US)",
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TY - JOUR

T1 - Safety and efficacy of low anterior resection for rectal cancer

T2 - 681 Consecutive cases from a specialty service

AU - Enker, Warren E.

AU - Merchant, Nipun

AU - Cohen, Alfred M.

AU - Lanouette, Nicole M.

AU - Swallow, Carol

AU - Guillem, Jose

AU - Paty, Philip

AU - Minsky, Bruce

AU - Weyrauch, Katherine

AU - Quan, Stuart H Q

PY - 1999/10

Y1 - 1999/10

N2 - Objective: To determine perioperative morbidity, survival, and local failure rates in a large group of consecutive patients with rectal cancer undergoing low anterior resection by multiple surgeons on a specialty service. The primary objective was to assess the surgical complications associated with preoperative radiation sequencing. Summary Background Data: The goals in the treatment of rectal cancer are cure, local control, and preservation of sphincter, sexual, and bladder function. Surgical resection using sharp perimesorectal dissection is important for achieving these goals. The complications and mortality rate of this surgical strategy, particularly in the setting of preoperative chemoradiation, have not been well defined. Methods: There were 1233 patients with primary rectal cancer treated at the authors' cancer center from 1987 to 1995. Of these, 681 underwent low anterior resection and/or coloanal anastomosis for primary rectal cancer. The surgical technique used the principles of sharp perimesorectal excision. Morbidity and mortality rates were compared between patients receiving preoperative chemoradiation (Preop RT, n = 150) and those not receiving preoperative chemoradiation (No Preop RT, n = 531). Recurrence and survival data were determined in patients undergoing curative resection (n = 583, 86%) among three groups of patients: those receiving Preop RT (n = 131), those receiving postoperative chemoradiation (Postop RT, n = 110), and those receiving no radiation therapy (No RT, n = 342). Results: The perioperative mortality rate was 0.6% (4/681). Postoperative complications occurred in 22% (153/681). The operative time, estimated blood loss, and rate of pelvic abscess formation without associated leak were higher in the Preop RT group than the No Preop RT group. However, the overall complication rate, rate of wound infection, anastomotic leak, and length of hospital stay were no different between Preop RT and No Preop RT patients. With a median follow-up of 45.6 months, the overall actuarial 5-year recurrence rate for patients undergoing curative resection (n = 583) was 19%, with 4% having local recurrence only, 12% having distant recurrence, and 3% having both local and distant recurrence, for an overall local recurrence rate of 7%. The actuarial 5-year overall survival rate was 81%; the disease-free survival rate was 75% and the local recurrence rate was 10%. The overall survival rate was similar between Preop RT (85%), Postop RT (72%), and No RT (83%) patients (p = 0.10), whereas the disease-free survival rate was significantly worse for Postop RT (65%) patients compared with Preop RT (79%) and No RT (77%) patients (p = 0.04). Conclusion: The use of preoperative chemoradiation results in increased operative time, blood loss, and pelvic abscess formation but does not increase the rate of anastomotic leaks or the length of hospital stay after low anterior resection for rectal cancer. The 5-year actuarial overall survival rate for patients undergoing curative resection exceeded 80%, with a local recurrence rate of 10%.

AB - Objective: To determine perioperative morbidity, survival, and local failure rates in a large group of consecutive patients with rectal cancer undergoing low anterior resection by multiple surgeons on a specialty service. The primary objective was to assess the surgical complications associated with preoperative radiation sequencing. Summary Background Data: The goals in the treatment of rectal cancer are cure, local control, and preservation of sphincter, sexual, and bladder function. Surgical resection using sharp perimesorectal dissection is important for achieving these goals. The complications and mortality rate of this surgical strategy, particularly in the setting of preoperative chemoradiation, have not been well defined. Methods: There were 1233 patients with primary rectal cancer treated at the authors' cancer center from 1987 to 1995. Of these, 681 underwent low anterior resection and/or coloanal anastomosis for primary rectal cancer. The surgical technique used the principles of sharp perimesorectal excision. Morbidity and mortality rates were compared between patients receiving preoperative chemoradiation (Preop RT, n = 150) and those not receiving preoperative chemoradiation (No Preop RT, n = 531). Recurrence and survival data were determined in patients undergoing curative resection (n = 583, 86%) among three groups of patients: those receiving Preop RT (n = 131), those receiving postoperative chemoradiation (Postop RT, n = 110), and those receiving no radiation therapy (No RT, n = 342). Results: The perioperative mortality rate was 0.6% (4/681). Postoperative complications occurred in 22% (153/681). The operative time, estimated blood loss, and rate of pelvic abscess formation without associated leak were higher in the Preop RT group than the No Preop RT group. However, the overall complication rate, rate of wound infection, anastomotic leak, and length of hospital stay were no different between Preop RT and No Preop RT patients. With a median follow-up of 45.6 months, the overall actuarial 5-year recurrence rate for patients undergoing curative resection (n = 583) was 19%, with 4% having local recurrence only, 12% having distant recurrence, and 3% having both local and distant recurrence, for an overall local recurrence rate of 7%. The actuarial 5-year overall survival rate was 81%; the disease-free survival rate was 75% and the local recurrence rate was 10%. The overall survival rate was similar between Preop RT (85%), Postop RT (72%), and No RT (83%) patients (p = 0.10), whereas the disease-free survival rate was significantly worse for Postop RT (65%) patients compared with Preop RT (79%) and No RT (77%) patients (p = 0.04). Conclusion: The use of preoperative chemoradiation results in increased operative time, blood loss, and pelvic abscess formation but does not increase the rate of anastomotic leaks or the length of hospital stay after low anterior resection for rectal cancer. The 5-year actuarial overall survival rate for patients undergoing curative resection exceeded 80%, with a local recurrence rate of 10%.

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