Anastomotic leakage and permanent stoma after short- course radiotherapy versus long-course chemoradiotherapy for rectal cancer resection: a retrospective cohort study
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Neoadjuvant radiotherapy is widely used for stage II–III rectal cancer but may impair anastomotic healing through chronic vascular injury and tissue fibrosis. Whether the lower total radiation dose delivered with short-course radiotherapy (SCRT) reduces anastomotic leakage or permanent stoma formation compared with long-course chemoradiotherapy (LCCRT) remains uncertain. Methods This retrospective cohort study included patients with stage II–III rectal adenocarcinoma treated at a tertiary referral center between 2011 and 2024. Patients receiving SCRT or LCCRT followed by restorative minimally invasive rectal resection were compared. Patients undergoing abdominoperineal resection, Hartmann’s procedure, total pelvic exenteration, TaTME, upfront surgery, or planned open surgery were excluded. The primary outcomes were anastomotic leakage and permanent stoma formation; secondary outcomes included factors associated with permanent stoma and oncological outcomes. Results The analysis included 171 patients: 66 received SCRT and 105 received LCCRT. Baseline characteristics were generally comparable, although low rectal tumors were more frequent in the LCCRT group. Anastomotic leakage rates were similar between the SCRT and LCCRT groups (7.6% vs. 8.6%; p = 0.817), as were permanent stoma rates (7.6% vs. 11.4%; p = 0.412). On multivariable analysis, LCCRT was not independently associated with anastomotic leakage (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 0.39–3.86; p = 0.730) or permanent stoma formation (aOR, 1.90; 95% CI, 0.61–5.87; p = 0.265). Higher ypStage was independently associated with permanent stoma formation. Three-year overall survival and local recurrence-free survival did not differ significantly between the groups. Conclusions The lower total radiation dose delivered with SCRT did not result in a detectable reduction in anastomotic leakage or permanent stoma formation compared with LCCRT. Permanent stoma formation was associated with advanced post-treatment pathological stage. Larger prospective studies are needed to confirm these findings.
Source: Research Square
Institution: Taichung Veterans General Hospital
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225113145