Neoadjuvant Therapy and Surgery in Rectal Adenocarcinoma: Analysis of Patients with Complete Tumor Remission

Andrade, Vitor Augusto de; Leal, Raquel Franco; Fagundes, João José; Coy, Cláudio Saddy Rodrigues; Ayrizono, Maria de Lourdes Setsuko

doi:10.1016/j.jcol.2013.08.008

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…Total pathological response and local recurrence are object of study around the world in bigger series regarding timing of surgery after chemoradiation. 11,23,24 However, there is no study on this topic here due to a small number of subjects, and hence, lack of statistical relevance.…”

Section: Discussionmentioning

confidence: 98%

Recurrence pattern of rectal cancer after surgical treatment. Analysis of 122 patients in a tertiary care center

Sevá-Pereira

Cypreste

Filho

et al. 2018

Journal of Coloproctology

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Survival in rectal cancer has been related mainly to clinical and pathological staging. Recurrence is by far the most challenging issue when surgical treatment of rectal cancer is concerned. This study aims to establish a recurrence pattern for rectal adenocarcinoma submitted to surgical treatment between March 2003 and July 2016. After exclusion criteria were applied, one hundred twenty two patients were analyzed. Global recurrence was found in 22% of them, while 13.1% have had local recurrence. Disease-free survival was 23.9 months, in average, and medium follow-up was 34.13 months, varying from 6 to 115 months. Recurrence, in literature, is usually between 3 and 35% in 5 years, and shows a 5-years survival rate of only 5%. Around 50% of cases, recurrence is local, confined to pelvis. This data followed literature in most aspects evaluated, although finding a high rate of local recurrence remains a challenge in the seek for better surgical outcomes.

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Section: Discussionmentioning

confidence: 98%

Recurrence pattern of rectal cancer after surgical treatment. Analysis of 122 patients in a tertiary care center

Sevá-Pereira

Cypreste

Filho

et al. 2018

Journal of Coloproctology

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“…31 The degree of tumor regression is closely correlated with the prognosis of oncology. 32,34,35 Pathological complete remission indicates a good prognosis. 8,9,[18][19][20][21] Sloothaaket et al 33 found that the highest PCR rate (18.0%) could be obtained by prolonging the operation interval to 10-11 weeks after nCRT.…”

Section: Discussionmentioning

confidence: 99%

<p>Short-Term Clinical and Oncological Outcome of Prolonging Operation Interval After Neoadjuvant Chemoradiotherapy for Locally Advanced Middle and Low Rectal Cancer</p>

Yang¹,

Chen²,

Li³

et al. 2020

CMAR

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The purpose of this study is to evaluate the short-term clinical and oncological outcome of prolonging operation interval to 11 weeks after the end of radiotherapy for locally advanced middle and low rectal cancer. Methods: A total of 123 patients with stage II/III (cT3/T4 or N+) low and middle rectal cancer who had undergone operation after neoadjuvant chemoradiotherapy were selected. According to the interval time between the last radiotherapy and operation, they were assigned to a short-interval group (SG, <11 weeks, n=66) and long-interval group (LG, ≥11 weeks, n=57). The relations among interval time and short-term clinical outcome and oncological outcome were analyzed. Results: The analysis found that basic information, clinical characteristics, and preoperative treatment between the two groups had no significant difference. There were no differences in operation time, estimated intraoperative blood loss and postoperative complications. The rate of sphincter preservation in the low and middle rectum was 66.7% in the short-interval group and 59.7% in the long-interval group (P=0.42). The incidence of anastomotic leak in the long-interval group was higher than that in the short-interval group (P=0.08). There was no significant difference in the recovery time of intestinal function and median duration of hospitalization between the two groups. The pathological complete remission rate was 17.07%. Multivariate analysis showed interval time had no influence on pathological complete remission. There was no significant difference in 3-year overall survival and 3-year disease-free survival between the two groups. The risk of recurrence and metastasis in patients with positive lymph nodes was higher than those with negative lymph nodes (P<0.05), HR=4.812 (95% CI 2.4-9.648). Conclusion: Prolonging the interval time of operation to 11 weeks after neoadjuvant chemoradiotherapy for middle and low rectal cancer does not improve the pathologic complete remission, morbidity, and mortality. There was no significant effect on oncologic outcome after prolonging the operation interval. Therefore, it is safe to prolong the interval of operation to 11 weeks.

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“…Considering patients with complete tumor response in the rectum, 7% to 17% will have tumor involvement of lymph nodes (19,21) ; and in our study, this percentage was 10%. The preoperative analysis in order to select patients for a non-surgical treatment therefore, can jeopardize a percentage of patients with lymph node involvement, regardless of tumor regression in the rectum (1) . The pathologic evaluation of the lymph nodes of surgical specimens from patients with rectal cancer can have substantial impact on time to relapse and survival.…”

Section: P=0024)mentioning

confidence: 99%

NEOADJUVANT THERAPY AND SURGERY FOR RECTAL CANCER. Comparative study between partial and complete pathological response

Andrade

Coy

Leal

et al. 2016

Arq. Gastroenterol.

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-Background -The approach of locally advanced extra-peritoneal rectal adenocarcinoma implies a treatment with neoadjuvant chemoradiotherapy associated with total mesorectal excision surgery. However, the tumors respond variably to this neoadjuvant therapy, and the mechanisms for response are not completely understood. Objective -Evaluate the variables related to the complete tumor response and the outcomes of patients who underwent surgery, comparing those with partial tumor regression and those with total remission of rectal lesion, at the pathological examination. Methods -Retrospective analysis of medical records of 212 patients operated between 2000 and 2010, in which 182 (85.9%) obtained partial remission at neoadjuvant therapy (Group 1) and 30 (14.1%), total remission (Group 2). Results -No difference was found between the groups in relation to gender, ethnicity, age, tumor distance from the anal verge, occurrence of metastases and synchronous lesions on preoperative staging, dose of radiotherapy and performed surgery. In Group 2, was verified high rate of complete remission when the time to surgery after neoadjuvant therapy was equal or less than 8 weeks (P=0.027), and a tendency of lower levels of pretreatment carcinoembryonic antigen (P=0.067). In pathological analysis, the Group 1 presented in relation to Group 2, more affected lymph nodes (average 1.9 and 0.5 respectively; P=0.003), more angiolymphatic (19.2% and 3.3%; P=0.032) and perineural involvement (15.4% and 0%; P=0.017) and greater number of lymph nodes examined (16.3 and 13.6; P=0.023). In the late follow-up, Group 1 also had lower overall survival than Group 2 (94.1 months and 136.4 months respectively; P=0.02) and disease-free survival (85.5 months and 134.6 months; P=0.004). There was no statistical difference between Group 2 and Group 1 in local recurrence (15% and 3.4%, respectively) and distant metastasis (28% and 13.8%, respectively). Conclusion -In this study, the only factor associated with complete remission of rectal adenocarcinoma was the time between neoadjuvant therapy and surgery. This group of patients had less affected lymph nodes, less angiolymphatic and perineural involvement, a longer overall and disease-free survival, but no significant statistical difference was observed in local recurrence and distant metastasis. Although the complete pathologic remission was associated with better prognosis, this not implied in the cure of the disease for all patients. HEADINGS -Neoadjuvant therapy. Colorectal surgery. Rectal neoplasms.

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Neoadjuvant Therapy and Surgery in Rectal Adenocarcinoma: Analysis of Patients with Complete Tumor Remission

Cited by 3 publications

References 27 publications

Recurrence pattern of rectal cancer after surgical treatment. Analysis of 122 patients in a tertiary care center

Recurrence pattern of rectal cancer after surgical treatment. Analysis of 122 patients in a tertiary care center

<p>Short-Term Clinical and Oncological Outcome of Prolonging Operation Interval After Neoadjuvant Chemoradiotherapy for Locally Advanced Middle and Low Rectal Cancer</p>

NEOADJUVANT THERAPY AND SURGERY FOR RECTAL CANCER. Comparative study between partial and complete pathological response

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