Prognostic Factors for Postoperative Morbidity and Tumour Response After Neoadjuvant Chemoradiation Followed by Resection for Rectal Cancer

Berkel, Annefleur E M; Woutersen, D.; Palen, Job van der; Klaase, Joost M.

doi:10.1007/s11605-014-2559-4

Cited by 15 publications

(16 citation statements)

References 28 publications

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“…According to the available data, short‐term outcomes of patients undergoing LAR after neoadjuvant RT are supposed to be less favorable compared to patients without neoadjuvant therapy. In irradiated patients, higher number of peroperative complications (longer operative time, more frequent complications during TME, higher peroperative blood loss) and more frequent postoperative complications have been reported by authors of many available studies …”

Section: Discussionmentioning

confidence: 91%

“…A higher number of peroperative complications after neoadjuvant RT implicates technically more demanding surgical preparation during LAR. Irradiated pelvis presents significant factor affecting technical difficulty of surgical dissection during total mesorectal excision . A higher postoperative morbidity of patients after neoadjuvant RT is conditioned mainly by compromised ability of irradiated pelvic tissues to heal and thus technically more demanding TME …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Anorectal dysfunction after laparoscopic low anterior rectal resection for rectal cancer with and without radiotherapy (manometry study)

Ihnát

Slívová

Tulinský

et al. 2017

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Anorectal dysfunction after laparoscopic low anterior rectal resection for rectal cancer with and without radiotherapy (manometry study)

Ihnát

Slívová

Tulinský

et al. 2017

Journal of Surgical Oncology

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show abstract

“…In addition, Maggiori et al 57 found the reverse to be true in a group of patients undergoing laparoscopic total mesorectal excision, with fewer major complications, less infection-related morbidity, lower clinical anastomotic leak rates, and shorter LOS in patients with pCR. On the other hand, Duldulao et al 58 and Berkel et al 59 found no significant difference in postoperative complications between patients with pCR compared with non-pCR patients.…”

Section: Discussionmentioning

confidence: 93%

Predictors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer

et al. 2015

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Background Some patients with rectal cancer who receive neoadjuvant chemoradiotherapy (nCRT) achieve a pathologic complete response (pCR) and may be eligible for less radical surgery or non-operative management. The aim of this study was to identify variables that predict pCR after nCRT for rectal cancer and to examine the impact of pCR on postoperative complications. Methods A retrospective review was performed of the NCDB from 2006 to 2011. Patients with rectal cancer who received nCRT followed by radical resection were included in this study. Multivariable analysis of the association between clinicopathologic characteristics and pCR was performed, and propensity-adjusted analysis was used to identify differences in postoperative morbidity between pCR and non-pCR patients. Results A total of 23,747 patients were included in the study. Factors associated with pCR included lower tumor grade, lower clinical T and N stage, higher radiation dose, and delaying surgery by more than 6–8 weeks after the end of radiation, while lack of health insurance was linked with a lower likelihood of pCR. Complete response was not associated with an increased risk of major postoperative complications. Conclusions Several clinical, pathologic, and treatment variables can help to predict which patients are most likely to have pCR after nCRT for rectal cancer. Awareness of these variables can be valuable in counseling patients regarding prognosis and treatment options.

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“…The liver-first approach has been reported feasible and safe in several single-centre studies [13][14][15][16][17][18][19]. Since liver metastases are the main cause of death, a liver-first approach means that their elimination is not delayed by treatments directed at the primary tumour or the complications [20]. In the current study we used a modified liver-first approach and performed the liver resection in the time window between radiotherapy and rectal surgery.…”

Section: Discussionmentioning

confidence: 99%

Resection of synchronous liver metastases between radiotherapy and definitive surgery for locally advanced rectal cancer: short‐term surgical outcomes, overall survival and recurrence‐free survival

et al. 2017

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Aim There is debate as to the correct treatment algorithm sequence for patients with locally advanced rectal cancer with liver metastases. The aim of the study was to assess safety, resectability and survival after a modified 'liver-first' approach.Method This was a retrospective study of patients undergoing preoperative radiotherapy for the primary rectal tumour, followed by liver resection and, finally, resection of the primary tumour. Short-term surgical outcome, overall survival and recurrence-free survival are reported.Results Between 2009 and 2013, 45 patients underwent liver resection after preoperative radiotherapy. Thirtyfour patients (76%) received neoadjuvant chemotherapy, 24 (53%) concomitant chemotherapy during radiotherapy and 17 (43%) adjuvant chemotherapy. The median time interval from the last fraction of radiotherapy to liver resection and rectal surgery was 21 (range 7-116) and 60 (range 31-156) days, respectively. Rectal resection was performed in 42 patients but was not performed in one patient with complete response and two with progressive metastatic disease. After rectal surgery three patients did not proceed to a planned second stage liver (n = 2) or lung (n = 1) resection due to progressive disease. Clavien-Dindo ≥Grade III complications developed in 6.7% after liver resection and 19% after rectal resection. The median overall survival and recurrence-free survival in the patients who completed the treatment sequence (n = 40) were 49.7 and 13.0 months, respectively. Twenty of the 30 patients who developed recurrence underwent further treatment with curative intent. ConclusionThe modified liver-first approach is safe and efficient in patients with locally advanced rectal cancer and allows initial control of both the primary tumour and the liver metastases.Keywords Locally advanced rectal cancer, synchronus colorectal liver metastases, liver-first approach What does this paper add to the literature? The optimal management of patients with locally advanced rectal cancer and synchronous liver metastases is controversial. This study is the first to show that liver resection in the time window between radiotherapy and rectal surgery is a safe and efficient alternative to the traditional liver-first approach.

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Prognostic Factors for Postoperative Morbidity and Tumour Response After Neoadjuvant Chemoradiation Followed by Resection for Rectal Cancer

Abstract: Neoadjuvant chemoradiation followed by rectal resection is associated with significant postoperative morbidity but minimal postoperative mortality. A complete response rate of 22% was achieved.

Cited by 15 publications

References 28 publications

Anorectal dysfunction after laparoscopic low anterior rectal resection for rectal cancer with and without radiotherapy (manometry study)

Anorectal dysfunction after laparoscopic low anterior rectal resection for rectal cancer with and without radiotherapy (manometry study)

Predictors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer

Resection of synchronous liver metastases between radiotherapy and definitive surgery for locally advanced rectal cancer: short‐term surgical outcomes, overall survival and recurrence‐free survival

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