The 4-portal technique decreases adverse effects in preoperative radiotherapy for advanced rectal cancer: comparison between the 2-portal and the 4-portal techniques

Background This study evaluated the difference of postoperative complications according to the radiation technique after preoperative radiotherapy for rectal cancer. Methods Among 224 patients with rectal cancer who underwent preoperative radiotherapy, 159 patients were treated with the 2-portal technique and 65 patients with the 4-portal technique. Comparison was performed between these 2 groups. Results The 5-year disease-free survival and local recurrence rate showed no difference between the 2 groups. There was also no difference in postoperative mortality. However, the 4-portal group had a significantly lower morbidity rate of 36.9% than the 2-portal group of 54.1% (P = .02). The rate of major complications that needed reoperation was also significantly lower in the 4-portal group (0%) than the 2-portal group (11.9%) (P = .01). The anastomotic leakage rate was significantly lower in the former (2.8% vs 20.0%, P = .033). Conclusion The 4-portal technique is a better technique than the 2-portal technique for decreasing postoperative complications in preoperative radiotherapy for rectal cancer.