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    Contents lists available at ScienceDirect
    European Journal of Surgical Oncology
    Anastomotic leakage after anterior resection in patients with rectal cancer previously irradiated for prostate cancer
    Ingvar Sverrisson a, *, Folke Folkvaljon b, Abbas Chabok a, Par€ Stattin c, Kenneth Smedh a, Maziar Nikberg a
    a Colorectal Unit, Department of Surgery and Centre for Clinical Research of Uppsala University, Vastmanland€s Hospital Vasterås,€ Sweden
    b Uppsala University, Uppsala, Sweden
    c Department of Surgical Sciences, Uppsala University, Sweden
    Article history:
    Rectal cancer
    Prostate cancer
    Anastomotic leakage
    Radiation therapy 
    Introduction: There are little data on the post-operative outcome of anterior resection (AR) for rectal cancer in men who had received radiotherapy for prostate cancer previously. The aim of this study was to assess the rate of anastomotic leakage (AL) after AR in these patients. Methods: All men who underwent bowel resection because of rectal cancer between 2000 and 2016 and had been diagnosed previously with prostate cancer were identified by linking the Swedish Colorectal Cancer Registry with the National Prostate Cancer Register. The medical records of men who underwent AR and had previously received radiotherapy for prostate cancer were reviewed.
    Conclusions: In the combined national population-based registries, a minority of patients with rectal cancer had an AR after previous radiotherapy for prostate cancer. These patients were healthy with early cancer stages and, in this selected group of patients, the AL rate was much lower than that reported previously.
    © 2018 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (
    Rectal cancer and prostate cancer are the two most common types of cancer in men [1]. Curative treatment options for localized prostate cancer include radiotherapy (RT) and radical prostatec-tomy [2]. In some studies, RT for prostate cancer has been associ-ated with an increased risk of developing rectal cancer [3e8]. If such patients develop rectal cancer later in life, further radiation is not feasible because of the risk of cumulative radiation toxicity. Excellent local control can be achieved by treating patients with rectal cancer pre-operatively with RT followed by total mesorectal excision (TME) [9e13]. However, RT is a risk factor for the devel-opment of post-operative surgical complications, such as
    * Corresponding author. Department of Surgery, V€astmanland's Hospital V€asterås, SE-72189, V€asterås, Sweden.
    E-mail address: [email protected] (I. Sverrisson). 
    anastomotic leakage (AL), pelvic abscesses and deep perineal wound infections [14e16]. Increased surgical complications after surgery for rectal cancer in patients who were previously treated with high-dose RT for prostate cancer has been reported in two small cohort studies that included 20 patients in total [17,18]. The selection of a proper treatment strategy for this patient cohort is a clinical challenge and requires thorough consideration. Access to two nationwide registries, the Swedish Colorectal Cancer Registry (SCRCR) [19] and the National Prostate Cancer Register (NPCR) [20], allowed us to address the treatment strategies in these patients. The aim of this study was to assess the AL rate after anterior resection (AR) in patients with rectal cancer who had previously received RT for prostate cancer.