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Anastomotic leakage in rectal surgery after neoadjuvant therapy Montecatini Terme 28 maggio 2005 Dario Scala INT Napoli Anastomotic leakage in rectal surgery: risk factors TME Anastomosis height Protective stoma Neoadjuvant therapy Extension and tumor-related obstruction Gender Bowel preparation Intraoperative blood loss Pelvic drainage Co-morbidities Adjuvant therapy and rectal cancer Adjuvant Therapy for Patients with Colon and Rectum Cancer. NIH Consensus Statement 1990 Is there effective adjuvant therapy for patients with rectal cancer? We recommend adjuvant therapy for stage II and III rectal cancer Combined post-operative chemotherapy and radiation therapy improves local control and survival in stage II and III rectal cancer Postoperative RT randomized trials GITSG 48 Gy FISHER 46.5 Gy DUTCH 50 Gy DANISH 50 Gy SPLIT MRC III 40 Gy EORTC 46 Gy Local control in 2 trial (p0.005) Toxicity No influence on survival Preoperative vs postoperative RT Short Course 25Gy in 5 days Rider Stockholm I e II RCG ICRF Rotterdam Swedish Standard 45-50 Gy in 5 weeks VASAG I e II MSKCC MRC I e II EORTC PUCC Norway MRC Neoadjuvant concomitant radiochemotherapy Bosset (EORTC) 5FU/LV 45 Gy Chari 5FU-CDDP 45 Gy Grann 5FU/LV 50.4 Gy Rich 5FU PVI 50.4 Gy Valentini 5FU CI 37.8 Gy INT Napoli Tom/FU/OXA 45 Gy Neoadjuvant therapy and anastomotic leakage Is neoadjuvant therapy in rectal cancer a relevant risk factor for anastomotic leakage? What is the EBM report? Neoadjuvant therapy and anastomotic leakage: pathogenesis of the damage Fibrosis induced by radiotherapy is likelihood to provide hypoxic tissues and anastomosis Preoperative chemoradiotherapy for advanced rectal cancer results in a significant preoperative and postoperative immune dysfunction as indicated by depression of lymphocyte subpopulations, monocytes, granulocytes, and proinflammatory cytokine release Wichmann et al Dis Colon Rectum. 2003 Jul;46(7):875-87. Ne