Revista Espanola de Enfermedades Digestivas (Nov 2004)
Postoperative radiotherapy-induced morbidity in rectal cancer Morbilidad de la radioterapia postoperatoria en el cáncer de recto
Abstract
Objectives: we analyzed long-term morbidity and bowel function alteration after postoperative radiotherapy for rectal cancer following resection with anastomosis. Patients and methods: thirty-seven patients who underwent surgery with intention to cure and a minimal follow-up period of 3 years were included. These patients were divided into two groups: in the first group, 14 patients received postoperative chemo-radiotherapy, 5-fluorouracil plus folinic acid, and 45 Gy plus 5 Gy boost. In the second group, there were 23 patients regarded as controls. We designed a questionnaire about their bowel function and analyzed the morbidity detected in their follow-up. Results: the group that was treated with postoperative chemo-radiotherapy had more daily bowel movements (p = 0.03) and night-time movements (p = 0.04); incontinence (69.2 versus 17.4% in the control group; p = 0.002), and perianal skin irritation (p = 0.04) versus the control group. Although without meaningful differences, the group under treatment wore a pad more often, had more defecatory urgency, could distinguish worse gas from stool, and needed more frequently antidiarrheal measures. Major complications were present in 28.6% of the under-treatment group: three intestinal resections were performed due to actinic stenosis; one patient had a residual stercoral fistula; another had several occlusive crises solved with medical treatment. Conclusions: postoperative chemo-radiotherapy had a high morbidity rate, which determined a significant alteration in quality of life. Accuracy in indication is therefore necessary, as well as a consideration of other alternatives for treatment, such as preoperative chemo-radiotherapy and total mesorectal excision.Objetivos: analizar la morbilidad y alteración del funcionalismo rectal a largo plazo de la radioterapia postoperatoria tras resección con anastomosis en el cáncer de recto. Material y métodos: se incluyen 37 pacientes intervenidos con intención curativa y con una evolución mínima de 3 años. Se dividen en dos grupos: 14 tratados con quimio-radioterapia postoperatoria, 5-fluoracilo más ác. folínico y 45 Gy más "boost" de 5 Gy y 23 no tratados utilizados como grupo control. Se realizó una encuesta sobre su funcionalismo rectal y se analizó la morbilidad detectada en el seguimiento. Resultados: el grupo tratado con quimio-radioterapia postoperatoria presentaba mayor frecuencia defecatoria diaria (p=0,03) y nocturna (p=0,04); incontinencia en el 69,2% frente al 17,4% del grupo control (p=0,002) y mayor irritación perianal (p=0,04). Aunque sin diferencias significativas, el grupo tratado precisó usar más frecuentemente compresas, tenía más urgencia defecatoria, diferenciaba peor gases y heces y precisó más medidas antidiarreicas. El 28,6% del grupo tratado presentaron complicaciones mayores: 3 resecciones intestinales por estenosis actínicas quedando uno con una fístula estercorácea residual; otro tuvo varias crisis suboclusivas resueltas con tratamiento conservador. Conclusiones: la quimio-radioterapia postoperatoria tiene una alta tasa de morbilidad, que condiciona una alteración importante de la calidad de vida por lo que es necesario sopesar bien la indicación y tener presente las posibilidades que se abren con la quimio-radioterapia preoperatoria y la excisión mesorrectal total.
