{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T01:48:40Z","timestamp":1793411320544,"version":"4.5.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,10]]},"abstract":"\n BACKGROUND:<\/jats:title>\n Evidence regarding the effect of preoperative radiotherapy on anastomotic integrity remains conflicting in rectal cancer surgery. Prospective comparisons with appropriate controls are needed.<\/jats:p>\n <\/jats:sec>\n \n OBJECTIVE:<\/jats:title>\n This study aimed to assess the impact of preoperative radiotherapy on anastomotic leakage and stenosis after rectal cancer resection.<\/jats:p>\n <\/jats:sec>\n \n DESIGN:<\/jats:title>\n This was a post hoc analysis of a randomized controlled trial (NCT01211210).<\/jats:p>\n <\/jats:sec>\n \n SETTINGS:<\/jats:title>\n Data were retrieved from the leading center of the trial, which is a tertiary hospital.<\/jats:p>\n <\/jats:sec>\n \n PATIENTS:<\/jats:title>\n The full analysis population of 318 patients was included.<\/jats:p>\n <\/jats:sec>\n \n INTERVENTIONS:<\/jats:title>\n Patients were randomly assigned to receive preoperative radiation (50 Gy per 25 fractions) and 5-fluorouracil infusion, alone (arm A) or combined with oxaliplatin (arm B), or preoperative chemotherapy with 5-fluorouracil and oxaliplatin without radiation (arm C).<\/jats:p>\n <\/jats:sec>\n \n MAIN OUTCOME MEASURES:<\/jats:title>\n The rates of anastomotic leakage and stenosis were calculated for each treatment arm. Multivariate analysis was used to verify the effect of preoperative radiotherapy.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n The treatment arms were comparable in terms of most baseline characteristics, but more diversions were used in the chemoradiotherapy arms. Anastomotic leakage occurred in 20.2% of patients in arm A, 23.6% of patients in arm B, and 8.5% of patients in arm C (\n p<\/jats:italic>\n = 0.007). The corresponding rates of stenosis were 17.0%, 18.9%, and 6.8% (\n p<\/jats:italic>\n = 0.02). Multivariate analysis confirmed the correlation between preoperative radiotherapy and clinical leakage (\n p<\/jats:italic>\n = 0.02), which was associated with delayed stenosis (\n p<\/jats:italic>\n < 0.001). For patients undergoing chemoradiotherapy, radiation proctitis was identified as an independent risk factor for clinical leakage (\n p<\/jats:italic>\n = 0.01) and stenosis (\n p<\/jats:italic>\n < 0.001).\n <\/jats:p>\n <\/jats:sec>\n \n LIMITATIONS:<\/jats:title>\n The main limitations were discrepancies in stoma creation and chemotherapy regimen among the treatment arms.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Preoperative radiotherapy increases the risk of anastomotic leakage and stenosis after rectal cancer resection. Clinical leakage independently contributes to the development of stenosis.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/dcr.0000000000000665","type":"journal-article","created":{"date-parts":[[2016,9,7]],"date-time":"2016-09-07T09:36:19Z","timestamp":1473240979000},"page":"934-942","source":"Crossref","is-referenced-by-count":153,"title":["Impact of Preoperative Radiotherapy on Anastomotic Leakage and Stenosis After Rectal Cancer Resection: Post Hoc Analysis of a Randomized Controlled Trial"],"prefix":"10.1097","volume":"59","author":[{"given":"Qiyuan","family":"Qin","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tenghui","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhong","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Oncology, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Radiology, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianping","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20230814","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/S0140-6736(09)60484-0","article-title":"Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial.","volume":"373","author":"Sebag-Montefiore","year":"2009","journal-title":"Lancet"},{"key":"R2-20230814","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1056\/NEJMoa040694","article-title":"Preoperative versus postoperative chemoradiotherapy for rectal cancer.","volume":"351","author":"Sauer","year":"2004","journal-title":"N Engl J Med"},{"key":"R3-20230814","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1001\/jama.2015.10529","article-title":"Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial.","volume":"314","author":"Fleshman","year":"2015","journal-title":"JAMA"},{"key":"R4-20230814","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s00268-004-7375-7","article-title":"Predictive factors of stenosis after stapled colorectal anastomosis: prospective analysis of 179 consecutive patients.","volume":"28","author":"Bannura","year":"2004","journal-title":"World J Surg"},{"key":"R5-20230814","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1007\/s10350-008-9319-z","article-title":"Colorectal anastomotic stenosis after elective laparoscopic sigmoidectomy for diverticular disease: a prospective evaluation of 68 patients.","volume":"51","author":"Ambrosetti","year":"2008","journal-title":"Dis Colon Rectum"},{"key":"R6-20230814","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1097\/SLA.0b013e3182128929","article-title":"Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis.","volume":"253","author":"Mirnezami","year":"2011","journal-title":"Ann Surg"},{"key":"R7-20230814","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1002\/bjs.9748","article-title":"Oncological outcome following anastomotic leak in rectal surgery.","volume":"102","author":"Esp\u00edn","year":"2015","journal-title":"Br J Surg"},{"key":"R8-20230814","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1007\/BF02562119","article-title":"Colorectal anastomotic stenosis: results of a survey of the ASCRS membership.","volume":"32","author":"Luchtefeld","year":"1989","journal-title":"Dis Colon Rectum"},{"key":"R9-20230814","first-page":"277","article-title":"Neoadjuvant chemoradiation therapy and pathological complete response in rectal cancer.","volume":"3","author":"Ferrari","year":"2015","journal-title":"Gastroenterol Rep (Oxf)"},{"key":"R10-20230814","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1200\/JCO.2002.20.3.817","article-title":"Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial.","volume":"20","author":"Marijnen","year":"2002","journal-title":"J Clin Oncol"},{"key":"R11-20230814","doi-asserted-by":"crossref","first-page":"910956","DOI":"10.1155\/2014\/910956","article-title":"Does preoperative radio(chemo)therapy increase anastomotic leakage in rectal cancer surgery? A meta-analysis of randomized controlled trials.","volume":"2014","author":"Qin","year":"2014","journal-title":"Gastroenterol Res Pract"},{"key":"R12-20230814","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1111\/j.1463-1318.2004.00700.x","article-title":"Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients.","volume":"7","author":"Eriksen","year":"2005","journal-title":"Colorectal Dis"},{"key":"R13-20230814","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1111\/j.1463-1318.2007.01466.x","article-title":"Risk factors for anastomotic leakage after rectal cancer surgery: a case-control study.","volume":"10","author":"Jestin","year":"2008","journal-title":"Colorectal Dis"},{"key":"R14-20230814","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/BF00290192","article-title":"Efficacy of dilatations for anastomotic colorectal stenoses: prognostic factors.","volume":"9","author":"Pucciarelli","year":"1994","journal-title":"Int J Colorectal Dis"},{"key":"R15-20230814","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.1007\/BF02234598","article-title":"Results of reoperations in colorectal anastomotic strictures.","volume":"44","author":"Schlegel","year":"2001","journal-title":"Dis Colon Rectum"},{"key":"R16-20230814","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.surg.2009.10.012","article-title":"Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer.","volume":"147","author":"Rahbari","year":"2010","journal-title":"Surgery"},{"key":"R17-20230814","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1038\/nrgastro.2014.46","article-title":"Radiation enteropathy: pathogenesis, treatment and prevention.","volume":"11","author":"Hauer-Jensen","year":"2014","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"R18-20230814","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1148\/radiology.175.3.2343132","article-title":"Postirradiation changes in the pelvis: assessment with MR imaging.","volume":"175","author":"Sugimura","year":"1990","journal-title":"Radiology"},{"key":"R19-20230814","first-page":"189","article-title":"Magnetic resonance enterography findings of chronic radiation enteritis.","volume":"11","author":"Algin","year":"2011","journal-title":"Cancer Imaging"},{"key":"R20-20230814","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1002\/bjs.5506","article-title":"Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer.","volume":"93","author":"Bujko","year":"2006","journal-title":"Br J Surg"},{"key":"R21-20230814","doi-asserted-by":"crossref","first-page":"3827","DOI":"10.1200\/JCO.2012.42.9597","article-title":"Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04.","volume":"30","author":"Ngan","year":"2012","journal-title":"J Clin Oncol"},{"key":"R22-20230814","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1002\/bjs.6377","article-title":"Delaying surgery after neoadjuvant chemoradiotherapy for rectal cancer may reduce postoperative morbidity without compromising prognosis.","volume":"95","author":"Kerr","year":"2008","journal-title":"Br J Surg"},{"key":"R23-20230814","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1046\/j.1365-2168.2002.02136.x","article-title":"Retrospective study of acute toxicity following short-course preoperative radiotherapy.","volume":"89","author":"Hartley","year":"2002","journal-title":"Br J Surg"},{"key":"R24-20230814","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1097\/SLA.0b013e31827b8ed9","article-title":"Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group.","volume":"257","author":"Park","year":"2013","journal-title":"Ann Surg"},{"key":"R25-20230814","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1097\/SLA.0b013e31829068c5","article-title":"Preoperative chemoradiotherapy effects on anastomotic leakage after rectal cancer resection: a propensity score matching analysis.","volume":"259","author":"Chang","year":"2014","journal-title":"Ann Surg"},{"key":"R26-20230814","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1001\/jama.2015.12009","article-title":"Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial.","volume":"314","author":"Stevenson","year":"2015","journal-title":"JAMA"},{"key":"R27-20230814","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/S1470-2045(12)70187-0","article-title":"Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO\/ARO\/AIO-04 randomised phase 3 trial.","volume":"13","author":"R\u00f6del","year":"2012","journal-title":"Lancet Oncol"},{"key":"R28-20230814","doi-asserted-by":"crossref","first-page":"2773","DOI":"10.1200\/JCO.2010.34.4911","article-title":"Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized phase III trial.","volume":"29","author":"Aschele","year":"2011","journal-title":"J Clin Oncol"},{"key":"R29-20230814","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.suc.2012.09.014","article-title":"Complications of colorectal anastomoses: leaks, strictures, and bleeding.","volume":"93","author":"Davis","year":"2013","journal-title":"Surg Clin North Am"},{"key":"R30-20230814","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1007\/s11605-012-1936-0","article-title":"Influence of neoadjuvant radiotherapy on anastomotic leak after restorative resection for rectal cancer.","volume":"16","author":"Nisar","year":"2012","journal-title":"J Gastrointest Surg"},{"key":"R31-20230814","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/S1470-2045(10)70026-7","article-title":"Defining pelvic-radiation disease for the survivorship era.","volume":"11","author":"Andreyev","year":"2010","journal-title":"Lancet Oncol"},{"key":"R32-20230814","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1016\/S1470-2045(07)70341-8","article-title":"Gastrointestinal symptoms after pelvic radiotherapy: a new understanding to improve management of symptomatic patients.","volume":"8","author":"Andreyev","year":"2007","journal-title":"Lancet Oncol"},{"key":"R33-20230814","first-page":"133","article-title":"Surgical management of radiation enteritis.","volume":"99","author":"Galland","year":"1986","journal-title":"Surgery"},{"key":"R34-20230814","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1007\/s00268-004-7699-3","article-title":"Reappraisal of surgical treatment for radiation enteritis.","volume":"29","author":"Onodera","year":"2005","journal-title":"World J Surg"},{"key":"R35-20230814","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1002\/bjs.1800760627","article-title":"Ischaemic strictures in patients treated with a low anterior resection and perioperative radiotherapy for rectal carcinoma.","volume":"76","author":"P\u00e5hlman","year":"1989","journal-title":"Br J Surg"},{"key":"R36-20230814","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/S0895-4356(96)00236-3","article-title":"A simulation study of the number of events per variable in logistic regression analysis.","volume":"49","author":"Peduzzi","year":"1996","journal-title":"J Clin Epidemiol"}],"container-title":["Diseases of the Colon & Rectum"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00003453-201610000-00005","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,14]],"date-time":"2023-08-14T03:48:49Z","timestamp":1691984929000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00003453-201610000-00005"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10]]},"references-count":36,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2016]]}},"URL":"https:\/\/doi.org\/10.1097\/dcr.0000000000000665","relation":{},"ISSN":["0012-3706"],"issn-type":[{"value":"0012-3706","type":"print"}],"subject":[],"published":{"date-parts":[[2016,10]]}}}