Delaying surgery by more than 10 weeks after long-course neoadjuvant radiotherapy in locally advanced rectal cancer patients improves pathologic complete response

Giné, Pere Planellas; Fernández, Lídia Cornejo; Roses, H. Salvador; Pujolras, María Buxo; Coll, R; Yague, Xavier Hernandez; Subirats, Eugeni Canals; Garcia, Júlia Gil; Hermosa, J.I. Rodríguez; Cazador, Antoni Codina

doi:10.1007/s13304-020-00747-0

Cited by 5 publications

(1 citation statement)

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“…In an attempt to achieve higher rates of pCR, early adopters of W&W researched various approaches. These included escalating the radiation dose [23] and delaying the time interval between NCRT and surgery [24]. One study reported that a median interval of 18.7 weeks was required to achieve a strict cCR [25].…”

Section: Discussionmentioning

confidence: 99%

Does complete pathological response increase perioperative morbidity risk in rectal cancer?

Tiang,

Yeoh,

Othman

et al. 2024

Colorectal Disease

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AimThe optimal management of patients with clinical complete response after neoadjuvant treatment for rectal cancer is controversial. The aim of this study is to compare the morbidity between patients with locally advanced rectal cancer who have had a pathological complete response (pCR) or not after neoadjuvant chemoradiotherapy (NCRT) and total mesorectal excision (TME). The study hypothesis was that pCR may impact the surgical complication rate.MethodA retrospective cohort study was conducted of a prospectively maintained database in Australia and New Zealand, the Binational Colorectal Cancer Audit, that identified patients with locally advanced rectal cancer (<15 cm from anal verge) from 1 January 2007 to 31 December 2019. Patients were included if they had locally advanced rectal cancer and had undergone NCRT and proceeded to surgical resection.ResultsThere were 4584 patients who satisfied the inclusion criteria, 65% being male. The mean age was 63 years and 11% had a pCR (ypT0N0). TME with anastomosis was performed in 67.8% of patients, and the majority of the cohort received long‐course radiotherapy (81.7%). Both major and minor complications were higher in the TME without anastomosis group (17.3% vs. 14.7% and 30.6% vs. 20.8%, respectively), and the 30‐day mortality was 1.31%. In the TME with anastomosis group, pCR did not contribute to higher rates of surgical complications, but male gender (p < 0.0012), age (p < 0.0001), preoperative N stage (p = 0.0092) and American Society of Anesthesologists (ASA) score ≥3 (p < 0.0002) did. In addition, pCR had no significant effect (p = 0.44) but male gender (p = 0.0047) and interval to surgery (p = 0.015) contributed to higher rates of anastomotic leak. In the TME without anastomosis cohort, the only variable that contributed to higher rates of complications was ASA score ≥3 (p = 0.033).ConclusionPatients undergoing TME dissection for rectal cancer following NCRT showed no difference in complications whether they had achieved pCR or not.

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Section: Discussionmentioning

confidence: 99%