{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:44:11Z","timestamp":1787013851892,"version":"build-2736575974"},"reference-count":56,"publisher":"Wiley","issue":"1-2","license":[{"start":{"date-parts":[[2022,10,3]],"date-time":"2022-10-03T00:00:00Z","timestamp":1664755200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>As rectal cancer survival increases, more patients survive with potentially severe, long\u2010term gastrointestinal and genitourinary complications from radiotherapy. The burden of these complications for patients and healthcare services is unclear, which this review aims to quantify.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Systematic search of Medline and Embase for randomized\u2010controlled trials (RCTs) and multicentre observational studies published since 2000, reporting hospitalization\/procedural intervention for long\u2010term (&gt;6\u00a0months post\u2010treatment) gastrointestinal or genitourinary complications after radiotherapy and surgery for rectal cancer. Prevalence values were pooled in a meta\u2010analysis assuming random effects. Organ\u2010preservation patients were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      4044 records screened; 24 reports from 23 studies included (15 RCTs, 8 Observational), encompassing 15\u2009438 patients. Twenty\u2010one studies (median follow\u2010up 60\u2009months) reported gastrointestinal complications post\u2010radiotherapy: pooled prevalence 11% (95% confidence interval (95% CI) 8\u201314%). Thirteen reported small bowel obstruction: prevalence 9% (95% CI 6\u201312%), a 58% increased risk compared with surgery alone (RR 1.58, 95% CI 1.26\u20131.98,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u20095 studies). Seven reported fistulas: prevalence 1% (95% CI 1\u20132%). Thirteen reported genitourinary complications: prevalence 4% (95% CI 1\u20136%); RR 1.10 (95% CI 0.88\u20131.38,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u20093 studies) compared with surgery alone.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Over 10% of patients are hospitalized for long\u2010term complications following rectal cancer radiotherapy. Serious gastrointestinal complications are commonplace; late small bowel obstruction is more common in patients having radiotherapy and surgery compared with surgery alone. Patients and clinicians need to be aware of these risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.18059","type":"journal-article","created":{"date-parts":[[2022,10,3]],"date-time":"2022-10-03T07:20:20Z","timestamp":1664781620000},"page":"42-53","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Long\u2010term adverse effects and healthcare burden of rectal cancer radiotherapy: systematic review and\n                    <scp>meta\u2010analysis<\/scp>"],"prefix":"10.1111","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4885-5740","authenticated-orcid":false,"given":"Alastair J.","family":"Morton","sequence":"first","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre (BRC) Nottingham University Hospitals NHS Trust and the University of Nottingham  Nottingham UK"},{"name":"Nottingham Colorectal Service Nottingham University Hospitals NHS Trust  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adil","family":"Rashid","sequence":"additional","affiliation":[{"name":"NIHR Nottingham Biomedical Research Centre (BRC) Nottingham University Hospitals NHS Trust and the University of Nottingham  Nottingham UK"},{"name":"Nottingham Colorectal Service Nottingham University Hospitals NHS Trust  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9438-9640","authenticated-orcid":false,"given":"Joanna S. 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