الفهرس Only 14 pages are availabe for public view
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Abstract
Rectal cancer in Egypt represents a major problem as it affects young age population (mean age 40 years) and it presents with low rectal lesions and in late stages (T3 and T4 represent in 70% of cases). APR is done in 80% of our patients with high incidence of local recurrence (50%) and low long term survivals (30%), Surgery is the corner stone for the management, and the use of neoadjuvant chemo-radiation is the standard of care in locally advanced rectal cancer. An unsolved aspect of neoadjuvant chemo-radiation is the appropriate timing of surgery after completion of neoadjuvant chemo radiation. The objective of our study was to study the optimal timing of surgery after completion of neoadjuvant chemo radiation. Comparing the impact of performing surgery 6 - 8 weeks versus surgical delay 9-14 weeks after chemo radiation. A prospective randomized phase III clinical study that was carried out between May 2011 and September 2015, in National cancer Institute, Cairo university, Egypt. Fifty two patients with locally advanced (T3 - 4 and N- / +) rectal carcinoma were included in the study and were treated by pre operative concurrent chemo-radiation followed by surgery. The patients were randomized into two groups according to time of surgery after the end of neoadjuvant chemo radiotherapy, Arm 1 (26 patients): Surgery was performed 6 - 8 weeks and Arm 2 (26 patients): Surgery was performed 9-14 weeks after the end of chemo radiation. Comparing between both groups regarding: Types of performed surgery (APR or LAR). Types of surgical approaches (open or laparoscopic). Operation time length. Intra operative complications. Operative blood loss and blood transfusion. Performing diverting ileostomy. Length of hospital stay. Post operative complications (wound infection, anastomotic leak, pelvic abscess formation, anastomotic stenosis, stoma retraction or necrosis, stool incontinence, ileus or intestinal obstruction and urinary complications)