Critical Analysis of Post-Operative Morbidity and Mortality in Patients of Carcinoma Rectum Following Neoadjuvant Concurrent Chemoradiation Therapy

Abstract

Background: Carcinoma rectum is a prevalent malignancy that often presents at a locally advanced stage. Neoadjuvant Concurrent Chemoradiation Therapy (NACCRT) has become the cornerstone of management in locally advanced rectal cancers, potentially downstaging tumors and improving resectability. Despite these benefits, the impact of NACCRT on short-term postoperative outcomes—morbidity and mortality—warrants thorough investigation.

Methods: This prospective, observational study was conducted at a tertiary care center over two years. Patients with T3/4 or N+ rectal cancer received NACCRT, followed by definitive surgery (Abdomino-Perineal Resection, Low Anterior Resection, or Total Pelvic Exenteration). Perioperative data, including operative time, blood loss, postoperative complications, and 30-day mortality, were collected. Statistical analyses were performed using SPSS, and comparisons were made between open versus laparoscopic surgical approaches.

Results: A total of 67 patients with carcinoma rectum were included. The mean patient age was 50.87±16.63 years, and 65.7% were male. Most tumors (55.2%) were located in the lower rectum. After NACCRT, 47.8% of patients underwent Abdomino-Perineal Resection and 47.8% Low Anterior Resection. Laparoscopic surgery accounted for 52.2% of cases, with significantly lower intraoperative blood loss (p=0.019) and fall in hemoglobin (p=0.001) compared to open surgery. Overall short-term morbidity was comparable between laparoscopic and open groups regarding ICU stay, postoperative pain scores, and complication rates (e.g., anastomotic leak in 1 patient, re-exploration in 3). There was no 30-day mortality.

Conclusion: NACCRT followed by curative resection in locally advanced rectal cancer is feasible with acceptable short-term morbidity with no observed 30-day mortality. Laparoscopic surgery appears to confer certain intraoperative advantages, notably lower blood loss, without increasing complication rates. Further multicenter studies with larger cohorts are warranted to confirm these findings and refine perioperative management protocols.