Abstract
Rectal cancer is one of the most common malignancies of the gastrointestinal tract. We retrospectively reviewed 108 patients with rectal cancer who underwent neoadjuvant chemoradiotherapy followed by laparoscopic low anterior resection at K Hospital. The overall postoperative complication rate was 13%, while the anastomotic leakage rate was 7.4%. Nine patients required reoperation, mainly due to anastomotic leakage. The reoperation rate was lower among patients with a protective stoma than among those without a protective stoma (0% vs. 12.5%; RD = −12.5%; p = 0.028). The median postoperative hospital stay was 10.5 days. The mean number of harvested lymph nodes was 6.14 ± 3.9. Based on these findings, laparoscopic low anterior resection following neoadjuvant chemoradiotherapy appears to be a safe and feasible approach for the treatment of rectal cancer, with postoperative complication and reoperation rates comparable to those reported in previous studies.
Keywords
Rectal cancer, neoadjuvant chemoradiotherapy, laparoscopic surgery, anastomotic leakage.
References
[1]
1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. May-Jun 2024;74(3):229-263. doi:10.3322/caac.21834
Google Scholar
[2]
2. Benson AB, Venook AP, Adam M, et al. NCCN Guidelines® Insights: Rectal Cancer, Version 3.2024. Journal of the National Comprehensive Cancer Network : JNCCN. Aug 2024;22(6):366-375. doi:10.6004/jnccn.2024.0041
Google Scholar
[3]
3. Hofheinz RD, Fokas E, Benhaim L, et al. Localised rectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of oncology : official journal of the European Society for Medical Oncology. Sep 2025;36(9):1007-1024. doi:10.1016/j.annonc.2025.05.528
Google Scholar
[4]
4. Morcos B, Baker B, Al Masri M, Haddad H, Hashem S. Lymph node yield in rectal cancer surgery: Effect of preoperative chemoradiotherapy. European Journal of Surgical Oncology (EJSO). 2010/04/01/ 2010;36(4):345-349. doi:https://doi.org/10.1016/j.ejso.2009.12.006
Google Scholar
[5]
5. Doll D, Gertler R, Maak M, et al. Reduced lymph node yield in rectal carcinoma specimen after neoadjuvant radiochemotherapy has no prognostic relevance. World journal of surgery. Feb 2009;33(2):340-7. doi:10.1007/s00268-008-9838-8
Google Scholar
[6]
6. Sauer R, Liersch T, Merkel S, et al. 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. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Jun 1 2012;30(16):1926-33. doi:10.1200/jco.2011.40.1836
Google Scholar
[7]
7. Song J, Chen Z, Huang D, Xu B. Prognostic Impact of Pretreatment Elevated and Normalized Carcinoembryonic Antigen Levels After Neoadjuvant Chemoradiotherapy in Resected Locally Advanced Rectal Cancer Patients. Cancer management and research. 2021/05/07 2021;13(null):3713-3721. doi:10.2147/CMAR.S299364
Google Scholar
[8]
8. Hoàng Thị Tuyết BVQ, Trần Thị Kim Phượng. Kết quả hóa xạ trị đồng thời tiền phẫu trong ung thư trực tràng trung bình giai đoạn tiến triển tại chỗ. Tạp chí Y học Việt Nam, tập 544, số chuyên đề tháng 11/2024, trang 194–201. 2024;
Google Scholar
[9]
9. Seo N, Kim H, Cho MS, Lim JS. Response Assessment with MRI after Chemoradiotherapy in Rectal Cancer: Current Evidences. Korean journal of radiology. Jul 2019;20(7):1003-1018. doi:10.3348/kjr.2018.0611
Google Scholar
[10]
10. Patel UB, Taylor F, Blomqvist L, et al. Magnetic Resonance Imaging–Detected Tumor Response for Locally Advanced Rectal Cancer Predicts Survival Outcomes: MERCURY Experience. Journal of Clinical Oncology. 2011/10/01 2011;29(28):3753-3760. doi:10.1200/JCO.2011.34.9068
Google Scholar
[11]
11. Yang CS, Choi GS, Park JS, et al. Rectal tube drainage reduces major anastomotic leakage after minimally invasive rectal cancer surgery. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. Dec 2016;18(12):O445-o452. doi:10.1111/codi.13506
Google Scholar
[12]
12. Kinugasa T, Nagasu S, Murotani K, et al. Analysis of risk factors for anastomotic leakage after lower rectal Cancer resection, including drain type: a retrospective single-center study. BMC Gastroenterology. 2020/09/25 2020;20(1):315. doi:10.1186/s12876-020-01462-1
Google Scholar
[13]
13. Matthiessen P, Hallböök O, Rutegård J, Simert G, Sjödahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. Aug 2007;246(2):207-14. doi:10.1097/SLA.0b013e3180603024
Google Scholar
[14]
14. Yeow M, Soh S, Wong J, et al. Transanal tube versus defunctioning stoma after low anterior resection for rectal cancer: network meta-analysis of randomized controlled trials. BJS. 2022;109(10):900-903. doi:10.1093/bjs/znac170 %J BJS
Google Scholar
[15]
15. Niu L, Wang J, Zhang P, Zhao X. Protective ileostomy does not prevent anastomotic leakage after anterior resection of rectal cancer. The Journal of international medical research. Aug 2020;48(8):300060520946520. doi:10.1177/0300060520946520
Google Scholar
[16]
16. Jo A, Wilson MZ. From Diversion to Permanence: Trends in Ostomy Creation in Rectal Cancer Surgery. 2025;14(6):1913.
Google Scholar
[17]
17. Huibers CJ, de Roos MA, Ong KH. The effect of the introduction of the ERAS protocol in laparoscopic total mesorectal excision for rectal cancer. International journal of colorectal disease. Jun 2012;27(6):751-7. doi:10.1007/s00384-011-1385-3
Google Scholar
[18]
18. Tsai HL, Huang CW, Yeh YS, et al. Factors affecting number of lymph nodes harvested and the impact of examining a minimum of 12 lymph nodes in stage I-III colorectal cancer patients: a retrospective single institution cohort study of 1167 consecutive patients. BMC surgery. Apr 14 2016;16:17. doi:10.1186/s12893-016-0132-7
Google Scholar