Impact of neoadjuvant chemoradiotherapy on post-operative outcome in patients with rectal cancer

Shirish Tewari, Sophie Bondje, Vivek Gupta, Nick Reay-Jones


Background: Neoadjuvant chemoradiotherapy not only helps in downstaging the rectal cancer, it also reduces the rate of local recurrence but it has its own attendant risk factors. Our aim is to look into the implications of neoadjuvant chemoradiotherapy in patients with rectal cancer in our hospital.

Methods: Retrospective data was collected from the infoflex system of database for the patients who underwent neoadjuvant chemoradiotherapy between January 2016-December 2019 in our DGH. The data was analysed for demographics, type of surgery, histology, length of stay, complications and stoma reversal rates.

Results: Total 27 patients with rectal cancer during the study period underwent neoadjuvant chemoradiotherapy. 16 were male and 11 females. Age range was 33-82 year. 13 patients underwent APER, 8 Hartmann’s and 6 anterior resection with covering loop ileostomy. 5 patients initially required defunctioning sigmoid loop colostomy and one loop ileostomy prior to the start of neoadjuvant treatment. Histology showed 26 adenocarcinoma, and 1 squamous cell cancer. 3 patients had complete pathological response (cPR). Post-operative stay was from 5-32 days. 12 patients developed pelvic collection, 5 wound infection (4 perineal+1 abdominal), 5 had paralytic ileus, 1 patient had PR bleed, 2 anastomotic leak and 2 patients had chest related complications. Only 4 out of 6 loop ileostomies were reversed.  

Conclusions: Neoadjuvant treatment benefits come with its attendant complications. The tissue response to radiotherapy and chemotherapy and advanced tumor stage may contribute for the increased morbidity. Hopefully in future with the advent of new armamentarium, the degree of morbidity may come down.


Rectal cancer, Neoadjuvant chemoradiotherapy, Pathological complete response, Complete clinical response

Full Text:



Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg. 1982;69:613-6.

Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997. Arch Surg. 1998;133:894-9.

Bosset J, Collette L, Calais G, Mineur L, Maingon P. Radosevic-Jelic L. for EORTC Radiotherapy Group Trial 22921. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Medic. 2006;355(11):1114-23.

Gérard JP, Conroy T, Bonnetain F, Bouché O, Chapet O, Closon-Dejardin MT, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clinic Oncol. 2006;24(28):4620-5.

Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. German Rectal Cancer Study Group. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731-40.

Francois Y, Nemoz CJ, Baulieux J, Vignal J, Grandjean JP, Partensky C, et al. Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trial. J Clin Oncol. 1999;17: 2396.

MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. Bio Med J. 2006;333:779.

Brown G. Staging rectal cancer: endoscopic ultrasound and pelvic MRI. Canc Imag. 2008;S43-5.

Siddiqui AA, Fayiga Y, Huerta S. The role of endoscopic ultrasound in the evaluation of rectal cancer. Int Semin Surg Oncol. 2006;3:36.

Valls C, Andía E, Sánchez A, Gumà A, Figueras J, Torras J, et al. Hepatic metastases from colorectal cancer: preoperative detection and assessment of resectability with helical CT. Radiology. 2001;218:55-60.

Ansari N, Solomon MJ, Fisher RJ, Mackay J, Burmeister B, Ackland S, et al. Acute Adverse Events and Postoperative Complications in a Randomized Trial of Preoperative Short-course Radiotherapy Versus Long-course Chemoradiotherapy for T3 Adenocarcinoma of the Rectum: Trans-Tasman Radiation Oncology Group Trial (TROG 01.04). Ann Surg. 2017;265:882-8.

Ryan JE, Warrier SK, Lynch AC, Ramsay RG, Phillips WA, Heriot AG. Predicting pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a systematic review. Colorectal Dis. 2016;18(3):234–46.

Habr-Gama A, de Souza PM, Ribeiro U, Nadalin W, Gansl R, Sousa AH, et al. Low rectal cancer: impact of radiation and chemotherapy on surgical treatment. Dis Colon Rectum. 1998;41:1087-96.

Gustafsson CP, Gunnarsson U, Dahlstrand U, Lindforss U. Loop-ileostomy reversal-patient-related characteristics influencing time to closure. Int J Colorectal Dis. 2018;33:593-600.

Emmanuel A, Chohda E, Lapa C, Miles A, Haji A, Ellul J. Defunctioning Stomas Result in Significantly More Short-Term Complications Following Low Anterior Resection for Rectal Cancer. World J Surg. 2018;42:3755-64.