br Patients treated with RT
Patients treated with RT for prostate cancer did not have a higher risk for AL compared with those operated with AR without RT for prostate cancer, after adjustment for different confounders in a logistic regression model (OR, 1.57; 95% CI, 0.67e3.70) (Appendix 1).
Review of patient records
The medical records of all 63 patients operated with AR who had previously received RT for prostate cancer were reviewed. Four patients were excluded because of inaccurate registration as having undergone AR (Hartmann's or abdominoperineal excision were performed). Moreover, 26/59 patients had a PME and 33/59 pa-tients had a TME in this 2 , 3Diaminonaphthalene group. A diverting stoma was constructed in 50 patients (85%). A total of 12 patients (20%) had an AL, among whom one patient needed a re-laparotomy (Grade C) and five pa-tients needed other surgical interventions with or without general anaesthesia (Grade B). Two patients with an AL did not have a diverting stoma; one of them needed a re-laparotomy. Of the 12 patients that had AL, one patient had received pre-operative chemotherapy, and none had received additional pre-operative RT for rectal cancer. In eight patients (14%), the complications were graded as ClavieneDindo 3b (two wound ruptures, one wound infection, one explorative laparotomy where the anasto-mosis was intact, one stoma complication and three AL); in three of these patients, the complication was managed without a re-laparotomy (Table 3).
Stage IV rectal cancer was a risk factor (OR, 8.7; 95% CI, 1.04e73.38) for developing AL in patients who had undergone AR after being treated previously with RT for prostate cancer (Ap-pendix 2).
In this population-based study that used data from two national registries, 188 patients with rectal cancer who had previously received RT for prostate cancer were scrutinized. The majority of these patients had non-restorative surgery, most probably because of the awareness of an increased risk of anastomotic complications. The AL rate after AR in a selected group was 10%, and additional review of patient records and grading of the leakage according to ISGRC revealed that the leakage rate increased but was still much lower than that reported previously. The majority of these previ-ously irradiated patients who underwent AR were healthy and had a diverting stoma and early tumour stages, which are factors that probably explain the low re-laparotomy rate and the absence of 90-day mortality.
A symptomatic AL after anterior resection for rectal cancer has been reported to occur in up to 24% in prospective trials [23,24]; however, to our knowledge, only two small cohort studies have addressed the issue of post-operative AL in male patients with rectal cancer Transformation had been previously treated with RT for prostate cancer. Guandalino et al. reported a leakage rate of 62.5% in eight patients who had previously received curative RT for prostate cancer , while Buscail et al. reported a leakage rate of 50% in 12 patients who had previously received RT for metachronous or synchronous prostate cancer .
We report a leakage rate of 20%, which is considerably lower than those values and closer to previously published data on leakage rates [23e26]. The patients who underwent AR in the RT-prost group were a highly selective cohort in which the great ma-jority of individuals had a less-advanced tumour stage, lower ASA
Clinical characteristics of all patients with rectal cancer treated with a bowel resection in Sweden between 2000 and 2016.
for prostate cancer and
rectal cancer surgery (months)
Level of rectal tumour
Type of operation
RT, radiotherapy; PC, prostate cancer; IQR, interquartile range; ASA, American So-ciety of Anesthesiologists; SD, standard deviation; CRT, chemoradiotherapy; AR, anterior resection; APE, abdominoperineal excision; HP, Hartmann's procedure. a Includes “Uncertain” and “Indeterminable”.
Post-operative complications in patients who underwent bowel resection for rectal cancer in Sweden between 2000 and 2016 (before the review of medical records).
AR, anterior resection; APE, abdominoperineal excision; HP, Hartmann's procedure; RT, radiotherapy.
The P-value for unequal distribution of “Any complication” among patients with and without RT for PC was not significant for any type of surgery.
scores and a diverting loop ileostomy. Furthermore, even though the distance from the tumour to the anal verge was >5 cm in 53% of the patients in the RT-prost group, only 34% of them had an AR with a large proportion of PME. This probably indicates the surgeon's awareness of the possible risk of AL in a previously irradiated pelvis.