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Long-term adverse effects and healthcare burden of rectal cancer radiotherapy: systematic review and meta-analysis.

Morton, Alastair J.; Rashid, Adil; Shim, Joanna S.C.; West, Joe; Humes, David J.; Grainge, Matthew J.


Alastair J. Morton

Adil Rashid

Joe West

David J. Humes

Matthew J. Grainge


As rectal cancer survival increases, more patients survive with potentially severe, long-term gastrointestinal and genitourinary complications from radiotherapy. The burden of these complications for patients and healthcare services is unclear, which this review aims to quantify. Systematic search of Medline and Embase for randomized-controlled trials (RCTs) and multicentre observational studies published since 2000, reporting hospitalization/procedural intervention for long-term (>6 months post-treatment) gastrointestinal or genitourinary complications after radiotherapy and surgery for rectal cancer. Prevalence values were pooled in a meta-analysis assuming random effects. Organ-preservation patients were excluded. 4044 records screened; 24 reports from 23 studies included (15 RCTs, 8 Observational), encompassing 15438 patients. Twenty-one studies (median follow-up 60 months) reported gastrointestinal complications post-radiotherapy: pooled prevalence 11% (95% confidence interval (95% CI) 8–14%). Thirteen reported small bowel obstruction: prevalence 9% (95% CI 6–12%), a 58% increased risk compared with surgery alone (RR 1.58, 95% CI 1.26–1.98, n = 5 studies). Seven reported fistulas: prevalence 1% (95% CI 1–2%). Thirteen reported genitourinary complications: prevalence 4% (95% CI 1–6%); RR 1.10 (95% CI 0.88–1.38, n =3 studies) compared with surgery alone. Over 10% of patients are hospitalized for long-term complications following rectal cancer radiotherapy. Serious gastrointestinal complications are commonplace; late small bowel obstruction is more common in patients having radiotherapy and surgery compared with surgery alone. Patients and clinicians need to be aware of these risks.


MORTON, A.J., RASHID, A., SHIM, J.S.C., WEST, J., HUMES, D.J. and GRAINGE, M.J. 2023. Long-term adverse effects and healthcare burden of rectal cancer radiotherapy: systematic review and meta-analysis. ANZ journal of surgery [online], 93(1-2), pages 42-53. Available from:

Journal Article Type Article
Acceptance Date Sep 8, 2022
Online Publication Date Oct 3, 2022
Publication Date Feb 28, 2023
Deposit Date Oct 11, 2022
Publicly Available Date Oct 11, 2022
Journal ANZ journal of surgery
Print ISSN 1445-1433
Electronic ISSN 1445-2197
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 93
Issue 1-2
Pages 42-53
Keywords Complications; Obstruction; Radiotherapy; Rectal cancer
Public URL
Additional Information This article has been published with separate supporting information. This supporting information has been incorporated into a single file on this repository and can be found at the end of this document.


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