Standard versus longer interval of radical resection after neoadjuvant chemoradiotherapy in locally advanced rectal cancer: A 20-year single-center experience & propensity-score matching
Khamzina S. Lee J. Ryoo S.-B. Kim M.J. Park J.W. Kang H.-C. Chie E.K. Lee D.-W. Han S.-W. Kim T.-Y. Jeong S.-Y. Park K.J.
January 2023John Wiley and Sons Inc
Journal of Surgical Oncology
2023#127Issue 1119 - 131 pp.
Background and Objectives: Despite the standard interval of 6−8 weeks between neoadjuvant chemoradiotherapy (nCRT) and surgery, it is debated whether an interval of >8 weeks increases the pathologic complete response (pCR) rate. We investigated the interval between nCRT and surgery, and its impact on oncological outcomes and postoperative complications in patients with locally advanced rectal cancer. Methods: We retrospectively reviewed patients with rectal cancer who underwent total mesorectal excision after long-course nCRT between 2000 and 2020. They were divided into two groups—those who underwent surgery at 6−8 and >8 weeks after nCRT. Surgical outcomes (stoma rate and postoperative complications), pCR, tumor regression grade (TRG), recurrence-free survival (RFS), and overall survival (OS) were compared. Results: We selected 770/1153 patients with rectal cancer, including 502 and 268 patients surgically treated at 6−8 and >8 weeks after nCRT, respectively. The pCR rates were similar between the two groups (14.7% vs. 15.3%, p = 0.836), while the TRG was significantly better in the >8 weeks group (p = 0.267). Additionally, the postoperative complications, recurrence, 5-year RFS, and OS rates were not significantly different between the two groups. Conclusions: Although tumor regression increased in the >8 weeks group, the oncological benefits of surgery >8 weeks after nCRT remain uncertain.
neoadjuvant chemoradiotherapy , pathologic complete response , postoperative complications , rectal cancer
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Department of Colorectal Surgery, Multidisciplinary City Hospital N1, Nur-Sultan, Kazakhstan
Department of Surgery, National Research Oncology Center, Nur-Sultan, Kazakhstan
Division of Colorectal Surgery, Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
Colorectal Cancer Center, Seoul National University Cancer Hospital, Seoul, South Korea
Cancer Research Institute, Seoul National University, Seoul, South Korea
Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
Division of Hematooncology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
Department of Colorectal Surgery
Department of Surgery
Division of Colorectal Surgery
Colorectal Cancer Center
Cancer Research Institute
Department of Radiation Oncology
Division of Hematooncology
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