[Perineal wound complications following preoperative radiotherapy for rectal cancer]

Every year, approximately 1200 new cases of rectal cancer are registered in Denmark. Preoperative radiation therapy alone or in combination with chemotherapy (chemo-radiation) is a gold standard in the treatment of patients with T3 and T4 tumours. Although it carries a good response rate, preoperative radiation is associated with significant morbidity including wound infection and delayed healing. The aim of this study is to clarify the effects of preoperative radiotherapy on wound healing in patients who underwent abdominoperineal excision and primary wound closure for rectum cancer.

In the period from 2001 to 2005, a total of 49 patients with rectum cancer underwent abdominoperineal excision with primary wound closure. Of these patients, 17 had preoperative radiotherapy.

There was a significantly higher incidence of major wound complications in radiotherapy-treated patients compared to patients treated with operation alone (71% versus 26%). The median wound healing time was 122 days for patients treated with radiotherapy and 22 days for patients treated with operation alone. There was no difference in hospitalisation time following surgery.

Preoperative radiotherapy for rectal cancer is an effective treatment modality in locally advanced rectum cancer but it carries a high risk of perineal wound complications. Alternative procedures to primary perineal wound closure should therefore be considered for these patients.