Optimal timing of surgery after neoadjuvant chemoradiation therapy in locally advanced rectal cancer.
10.4174/jkss.2013.84.6.338
- Author:
Duck Hyoun JEONG
1
;
Han Beom LEE
;
Hyuk HUR
;
Byung Soh MIN
;
Seung Hyuk BAIK
;
Nam Kyu KIM
Author Information
1. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. namkyuk@yuhs.ac
- Publication Type:Original Article
- Keywords:
Rectal neoplasm;
Neoadjuvant therapy;
Chemoradiotherapy;
Preoperative period;
Surgery
- MeSH:
Chemoradiotherapy;
Disease-Free Survival;
Female;
Humans;
Male;
Neoadjuvant Therapy;
Polymerase Chain Reaction;
Postoperative Complications;
Preoperative Period;
Rectal Neoplasms;
Recurrence
- From:Journal of the Korean Surgical Society
2013;84(6):338-345
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: The optimal time between neoadjuvant chemoradiotherapy (CRT) and surgery for rectal cancer has been debated. This study evaluated the influence of this interval on oncological outcomes. METHODS: We compared postoperative complications, pathological downstaging, disease recurrence, and survival in patients with locally advanced rectal cancer who underwent surgical resection <8 weeks (group A, n = 105) to those who had surgery > or =8 weeks (group B, n = 48) after neoadjuvant CRT. RESULTS: Of 153 patients, 117 (76.5%) were male and 36 (23.5%) were female. Mean age was 57.8 years (range, 28 to 79 years). There was no difference in the rate of sphincter preserving surgery between the two groups (group A, 82.7% vs. group B, 77.6%; P = 0.509). The longer interval group had decreased postoperative complications, although statistical significance was not reached (group A, 28.8% vs. group B, 14.3%; P = 0.068). A total of 111 (group A, 75 [71.4%] and group B, 36 [75%]) patients were downstaged and 26 (group A, 17 [16.2%] and group B, 9 [18%]) achieved pathological complete response (pCR). There was no significant difference in the pCR rate (P = 0.817). The longer interval group experienced significant improvement in the nodal (N) downstaging rate (group A, 46.7% vs. group B, 66.7%; P = 0.024). The local recurrence (P = 0.279), distant recurrence (P = 0.427), disease-free survival (P = 0.967), and overall survival (P = 0.825) rates were not significantly different. CONCLUSION: It is worth delaying surgical resection for 8 weeks or more after completion of CRT as it is safe and is associated with higher nodal downstaging rates.
