The effect of neoadjuvant chemoradiotherapy on perioperative outcomes in rectal cancer patients following stoma reversal—a retrospective cohort analysis
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: Anastomotic leak after reversal of an ostomy is a significant complication in rectal cancer patients. The effects of neoadjuvant chemoradiotherapy (NCRT) on outcomes following stoma reversal are not well established. The aim of our study was to evaluate the effect of NCRT on outcomes in rectal cancer patients following stoma reversal. Methods: We performed a [2005–2012] retrospective cohort analysis of the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP), including adult (≥18 years) rectal cancer patients who had elective stoma reversal. Patients were stratified into those who received NCRT and those who did not. Primary outcomes were anastomotic leak and major complications. Secondary outcomes were mortality and length of stay (LOS). Regression analysis was performed confounding variables. Results: We identified a total of 461 patients of which 259 received NCRT while 202 did not. The mean age was 52±10 years, and 28% had an American Society of Anesthesiologists (ASA) class III–IV. Overall, the rate of anastomotic leak was 6.8%. Major complications were seen in 5.6% of patients with the most common complication being organ space infection (3.2%). There was no difference between the two groups regarding anastomotic leak (7.9% vs. 6.2%, P=0.22), major complications (5.1% vs. 6.4%, P=0.17), LOS {5 [3–5] vs. 4 [4–5] days, P=0.12}, or mortality (1.9% vs. 2.4%, P=0.26). On regression analysis, after adjusting for confounding variables, NCRT was not associated with anastomotic leaks [overall survival: odds ratio (OR) =1.03; 90% confidence interval (CI): 0.86–1.07], major complications (OR =1.97; 90% CI: 0.79–1.99), or mortality (OR =1.04; 90% CI: 0.59–1.12). Conclusions: Our findings suggested that NCRT for rectal cancer does not increase morbidity following stoma closure. Stoma closure is safe and should not be withheld based on NCRT.
DOI: 10.21037/jgo-24-558
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7117453131
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