Perioperative Complications After Proctectomy for Rectal Cancer

Abstract

Objective: Investigate the association between neoadjuvant treatment strategy and perioperative complications in patients undergoing proctectomy for nonmetastatic rectal cancer. Summary of Background Data: Neoadjuvant SC-TNT is an alternative to neoadjuvant CRT for rectal cancer. Some have argued that short-course radiation and extended radiation-to-surgery intervals increase operative difficulty and complication risk. However, the association between SC-TNT and surgical complications has not been previously investigated. Methods: This single-center retrospective cohort study included patients undergoing total mesorectal excision for nonmetastatic rectal cancer after SC-TNT or CRT between 2010 and 2018. Univariate analysis of severe POM and multiple secondary outcomes, including overall POM, intraoperative complications, and resection margins, was performed. Logistic regression of severe POM was also performed. Results: Of 415 included patients, 156 (38%) received SC-TNT and 259 (62%) received CRT. The cohorts were largely similar, though patients with higher tumors (69.9% vs 47.5%, P < 0.0001) or node-positive disease (76.9% vs 62.6%, P ¼ 0.004) were more likely to receive SC-TNT. We found no difference in incidence of severe POM (9.6% SC-TNT vs 12.0% CRT, P ¼ 0.46) or overall POM (39.7% SC-TNT vs 37.5% CRT, P ¼ 0.64) between cohorts. Neoadjuvant regimen was also not associated with a difference in severe POM (odds ratio 0.42, 95% confidence interval 0.04-4.70, P ¼ 0.48) in multivariate analysis. There was no significant association between neoadjuvant regimen and any secondary outcome. Conclusion:In rectal cancer patients treated with SC-TNT and proctectomy, we found no significant association with POM compared to patients undergoing CRT. SC-TNT does not significantly increase the risk of POM compared to CRT.

Predictive value of a serum tumor biomarkers scoring system for clinical stage II/III rectal cancer with neoadjuvant chemoradiotherapy

“…Although univariate analyses demonstrated that lower pre-NCRT CEA and CA19-9 levels were potential indicators of a better prognosis, the multivariate analysis proved that only the NSTB score and pathological TNM stage could independently determine the prognosis. In general, pathological indicators had a more robust predictive value than other indicators in determining the prognosis[ 8 ]; however, the multivariate analysis revealed that the NSTB score could predict outcomes better than pathological characteristics of lymphatic invasion, vascular invasion, nerve infiltration, and CRM invasion. Thus, we propose that the NSTB score should be used to guide the treatment and determine the prognosis of patients with RC of clinical stage II/III.…”

“…Pathological findings were generally recognized as the most effective indicators to predict the prognosis[ 8 ]. A previous study revealed that lymphatic invasion, perineural invasion, vascular invasion, CRM invasion, LN metastasis, and a higher tumor invasion stage can predict a worse outcome[ 4 ].…”

“…Multiple classes of molecular biomarkers have been studied as potential predictors for RC response but there is no sufficient evidence for any of them to be introduced into clinical practice[ 7 ]. Moreover, additional systematic chemotherapy could increase the toxicity [ 8 , 9 ]. Therefore, it is critical to identify predictive factors for clinical stage II/III patients and give additional chemotherapy or more aggressive treatment strategies.…”

“…Pathological indicators are generally considered to be the most effective predictive factors[ 10 , 11 ]. Unfortunately, pathological characteristics are difficult to obtain and quantitate and are usually affected by the operation and specimen-processing quality[ 8 , 9 ]. Moreover, the pathological indicators, which can only be obtained after surgery, do not assist in judging whether patients need additional chemotherapy before undergoing NCRT or surgery.…”

Predictive value of proteomic markers for advanced rectal cancer with neoadjuvant chemoradiotherapy

“…nCRT followed by surgery with a total mesorectal excision is the recommended treatment for patients with locally advanced rectal cancer. nCRT has been proven to be effective to downstage the primary tumor which may facilitate complete resection with negative surgical margins and significantly reduce local recurrence [ 1 , 2 ]. The efficacy of nCRT varies among individual patients ranging from pathological complete response (pCR; defined as ypT0N0) to progression of disease.…”