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      Long-term prognostic impact of surgical complications in the German Rectal Cancer Trial CAO/ARO/AIO-94 : Prognostic impact of surgical complications in patients with locally advanced rectal cancer

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          Abstract

          The influence of postoperative complications on survival in patients with locally advanced rectal cancer undergoing combined modality treatment is debatable. This study evaluated the impact of surgical complications on oncological outcomes in patients with locally advanced rectal cancer treated within the randomized CAO/ARO/AIO-94 (Working Group of Surgical Oncology/Working Group of Radiation Oncology/Working Group of Medical Oncology of the Germany Cancer Society) trial.

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          Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years.

          Rolf Sauer, Torsten Liersch, Susanne Merkel … (2012)
          Preoperative chemoradiotherapy (CRT) has been established as standard treatment for locally advanced rectal cancer after first results of the CAO/ARO/AIO-94 [Working Group of Surgical Oncology/Working Group of Radiation Oncology/Working Group of Medical Oncology of the Germany Cancer Society] trial, published in 2004, showed an improved local control rate. However, after a median follow-up of 46 months, no survival benefit could be shown. Here, we report long-term results with a median follow-up of 134 months. A total of 823 patients with stage II to III rectal cancer were randomly assigned to preoperative CRT with fluorouracil (FU), total mesorectal excision surgery, and adjuvant FU chemotherapy, or the same schedule of CRT used postoperatively. The study was designed to have 80% power to detect a difference of 10% in 5-year overall survival as the primary end point. Secondary end points included the cumulative incidence of local and distant relapses and disease-free survival. Of 799 eligible patients, 404 were randomly assigned to preoperative and 395 to postoperative CRT. According to intention-to-treat analysis, overall survival at 10 years was 59.6% in the preoperative arm and 59.9% in the postoperative arm (P = .85). The 10-year cumulative incidence of local relapse was 7.1% and 10.1% in the pre- and postoperative arms, respectively (P = .048). No significant differences were detected for 10-year cumulative incidence of distant metastases (29.8% and 29.6%; P = .9) and disease-free survival. There is a persisting significant improvement of pre- versus postoperative CRT on local control; however, there was no effect on overall survival. Integrating more effective systemic treatment into the multimodal therapy has been adopted in the CAO/ARO/AIO-04 trial to possibly reduce distant metastases and improve survival.
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            Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer.

            Nuh N. Rahbari, Jürgen Weitz, Werner Hohenberger … (2010)
            Anastomotic leakage represents a major complication after anterior resection of the rectum. The incidence of anastomotic leakage varies considerably among clinical studies in part owing to the lack of a standardized definition of this complication. The aim of the present article was to propose a definition and severity grading of anastomotic leakage after anterior rectal resection. After a literature review a consensus definition and severity grading of anastomotic leakage was developed within the International Study Group of Rectal Cancer. Anastomotic leakage should be defined as a defect of the intestinal wall at the anastomotic site (including suture and staple lines of neorectal reservoirs) leading to a communication between the intra- and extraluminal compartments. Severity of anastomotic leakage should be graded according to the impact on clinical management. Grade A anastomotic leakage results in no change in patients' management, whereas grade B leakage requires active therapeutic intervention but is manageable without re-laparotomy. Grade C anastomotic leakage requires re-laparotomy. The proposed definition and clinical grading is applicable easily in the setting of clinical studies. It should be applied in future reports to facilitate valid comparison of the results of different studies. Copyright 2010 Mosby, Inc. All rights reserved.
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              Risk factors for anastomotic leakage after resection of rectal cancer.

              M Parneix, Louise C. Laurent, E Rullier … (1998)
              The most important surgical complication following rectal resection with anastomosis is symptomatic anastomotic leakage, which is associated with a 6-22 per cent mortality rate. The aim of this retrospective study was to evaluate the risk factors for clinical anastomotic leakage after anterior resection for cancer of the rectum. From 1980 to 1995, 272 consecutive anterior resections for rectal cancer were performed by the same surgical team; 131 anastomoses were situated 5 cm or less from the anal verge. The associations between clinical anastomotic leakage and 19 patient-, tumour-, surgical-, and treatment-related variables were studied by univariate and multivariate analysis. The rate of clinical anastomotic leakage was 12 per cent (32 of 272). Multivariate analysis of the overall population showed that only male sex and level of anastomosis were independent factors for development of anastomotic leakage. The risk of leakage was 6.5 times higher for anastomoses situated less than 5 cm from the anal verge than for those situated above 5 cm; it was 2.7 times higher for men than for women. In a second analysis of low anastomoses (5 cm or less from the anal verge; n = 131), obesity was statistically associated with leakage. A protective stoma is suitable after sphincter-saving resection for rectal cancer for anastomoses situated at or less than 5 cm from the anal verge, particularly for men and obese patients.
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                Author and article information

                Journal
                Title: British Journal of Surgery
                Abbreviated Title: Br J Surg
                Publisher: Wiley
                ISSN: 00071323
                Publication date Created: October 2018
                Publication date (Print): October 2018
                Publication date (Electronic): May 30 2018
                Volume: 105
                Issue: 11
                Pages: 1510-1518
                Affiliations
                [1 ]Department of General, Visceral and Paediatric Surgery; University Medical Centre Göttingen; Göttingen Germany
                [2 ]Department of Medical Statistics; University Medical Centre Göttingen; Göttingen Germany
                [3 ]Department of Radiotherapy; University Medical Centre Erlangen; Erlangen Germany
                [4 ]Department of Surgery; Krankenhaus der Barmherzigen Brüder; St Veit an der Glan Austria
                [5 ]Department of Surgery; University Medical Centre Erlangen; Erlangen Germany
                [6 ]Department of General and Visceral Surgery; Klinikum Esslingen; Esslingen Germany
                [7 ]University Department of General and Visceral Surgery, Klinikum Oldenburg; Oldenburg Germany
                [8 ]Department of Radiotherapy and Oncology; University Medical Centre Frankfurt; Frankfurt/Main Germany
                Article
                DOI: 10.1002/bjs.10877
                PubMed ID: 29846017
                SO-VID: caeaad84-2ecb-4137-8125-388f06a806df
                Copyright © © 2018
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                http://doi.wiley.com/10.1002/tdm_license_1.1

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