D. M. Hayden1, C. Holmes1, A. Lasinski1, S. Nassoiy1, M. Chiodo2, K. Wolin1, T. Saclarides1 1Loyola University Medical Center,Department of General Surgery,Maywood, Illinois, USA 2Loyola University Medical Center,Stritch School Of Medicine,Maywood, Illinois, USA
Introduction: The treatment course of locally advanced rectal cancer is long, tedious and wrought with morbidity. This disease burden is underappreciated; however there may be amenable factors to improve peri- and postoperative outcomes.
Methods: Retrospective review of patients with stage II and III rectal cancer treated with neoadjuvant chemoradiation followed by radical resection at a single tertiary care center 2006-2013.
Results: 57 patients were included; mean age was 60.4 (36-82); 57.9% were male. Mean BMI was 29.0 (19.0-43.4); 40.4% were obese and 15.8% had BMI>35. Co-morbidities were common: 40.4% had hypertension, 24.6% diabetes, 8.8% CAD and 5.3% had COPD. 12.3% were current smokers and 49.1% previously smoked. 37 (64.9%) patients had LAR and 35.1% had APR. Only 7.0% had laparoscopic resection. Mean operative time 355.2 (120-630) minutes. Mean blood loss was 452 ml (50.0-3000); 14.0% required transfusion and 28.1% ICU admission. Mean length of stay was 11.0 (4.0-62.0) days. 45.6% had complications, most commonly fever, ileus and abscess. 36.8% of patients required readmission. Obese patients had longer LOS that trended toward significance (13.6 vs.9.2, p=0.078); however, complications were not more common. Those with BMI>35 had higher risk of pneumonia, DVT and sepsis (p=0.02-0.05). Current and previous smokers were more likely to be readmitted (p=0.043). 4 of the 6 patients discharged to rehab/skilled nursing had BMI>30.
Conclusion: The treatment of irradiated rectal cancer involves morbid operations, complications and readmissions. Our patients are obese with multiple comorbidities that contribute to poorer outcomes. However, lifestyle interventions like exercise and smoking cessation at diagnosis may help to decrease this burden.