Optimal timing of surgery after neoadjuvant chemoradiation therapy in locally advanced rectal cancer

Duck Hyoun Jeong, Han Beom Lee, Hyuk Hur, Byung Soh Min, Seung Hyuk Baik, Nam Kyu Kim

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Purpose: The optimal time between neoadjuvant chemoradiotherapy (CRT) and surgery for rectal cancer has been debated. This study evaluated the influence of this interval on oncological outcomes. Methods: We compared postoperative complications, pathological downstaging, disease recurrence, and survival in patients with locally advanced rectal cancer who underwent surgical resection ≥8 weeks (group A, n = 105) to those who had surgery ≥8 weeks (group B, n = 48) after neoadjuvant CRT. Results: Of 153 patients, 117 (76.5%) were male and 36 (23.5%) were female. Mean age was 57.8 years (range, 28 to 79 years). There was no difference in the rate of sphincter preserving surgery between the two groups (group A, 82.7% vs. group B, 77.6%; P = 0.509). The longer interval group had decreased postoperative complications, although statistical significance was not reached (group A, 28.8% vs. group B, 14.3%; P = 0.068). A total of 111 (group A, 75 [71.4%] and group B, 36 [75%]) patients were downstaged and 26 (group A, 17 [16.2%] and group B, 9 [18%]) achieved pathological complete response (pCR). There was no significant difference in the pCR rate (P = 0.817). The longer interval group experienced significant improvement in the nodal (N) downstaging rate (group A, 46.7% vs. group B, 66.7%; P = 0.024). The local recurrence (P = 0.279), distant recurrence (P = 0.427), disease-free survival (P = 0.967), and overall survival (P = 0.825) rates were not significantly different. Conclusion: It is worth delaying surgical resection for 8 weeks or more after completion of CRT as it is safe and is associated with higher nodal downstaging rates.

Original languageEnglish
Pages (from-to)338-345
Number of pages8
JournalJournal of the Korean Surgical Society
Volume84
Issue number6
DOIs
Publication statusPublished - 2013 Jun 1

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Neoadjuvant Therapy
Chemoradiotherapy
Rectal Neoplasms
Recurrence
Survival
Disease-Free Survival

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Jeong, Duck Hyoun ; Lee, Han Beom ; Hur, Hyuk ; Min, Byung Soh ; Baik, Seung Hyuk ; Kim, Nam Kyu. / Optimal timing of surgery after neoadjuvant chemoradiation therapy in locally advanced rectal cancer. In: Journal of the Korean Surgical Society. 2013 ; Vol. 84, No. 6. pp. 338-345.
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abstract = "Purpose: The optimal time between neoadjuvant chemoradiotherapy (CRT) and surgery for rectal cancer has been debated. This study evaluated the influence of this interval on oncological outcomes. Methods: We compared postoperative complications, pathological downstaging, disease recurrence, and survival in patients with locally advanced rectal cancer who underwent surgical resection ≥8 weeks (group A, n = 105) to those who had surgery ≥8 weeks (group B, n = 48) after neoadjuvant CRT. Results: Of 153 patients, 117 (76.5{\%}) were male and 36 (23.5{\%}) were female. Mean age was 57.8 years (range, 28 to 79 years). There was no difference in the rate of sphincter preserving surgery between the two groups (group A, 82.7{\%} vs. group B, 77.6{\%}; P = 0.509). The longer interval group had decreased postoperative complications, although statistical significance was not reached (group A, 28.8{\%} vs. group B, 14.3{\%}; P = 0.068). A total of 111 (group A, 75 [71.4{\%}] and group B, 36 [75{\%}]) patients were downstaged and 26 (group A, 17 [16.2{\%}] and group B, 9 [18{\%}]) achieved pathological complete response (pCR). There was no significant difference in the pCR rate (P = 0.817). The longer interval group experienced significant improvement in the nodal (N) downstaging rate (group A, 46.7{\%} vs. group B, 66.7{\%}; P = 0.024). The local recurrence (P = 0.279), distant recurrence (P = 0.427), disease-free survival (P = 0.967), and overall survival (P = 0.825) rates were not significantly different. Conclusion: It is worth delaying surgical resection for 8 weeks or more after completion of CRT as it is safe and is associated with higher nodal downstaging rates.",
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Optimal timing of surgery after neoadjuvant chemoradiation therapy in locally advanced rectal cancer. / Jeong, Duck Hyoun; Lee, Han Beom; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk; Kim, Nam Kyu.

In: Journal of the Korean Surgical Society, Vol. 84, No. 6, 01.06.2013, p. 338-345.

Research output: Contribution to journalArticle

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AU - Jeong, Duck Hyoun

AU - Lee, Han Beom

AU - Hur, Hyuk

AU - Min, Byung Soh

AU - Baik, Seung Hyuk

AU - Kim, Nam Kyu

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N2 - Purpose: The optimal time between neoadjuvant chemoradiotherapy (CRT) and surgery for rectal cancer has been debated. This study evaluated the influence of this interval on oncological outcomes. Methods: We compared postoperative complications, pathological downstaging, disease recurrence, and survival in patients with locally advanced rectal cancer who underwent surgical resection ≥8 weeks (group A, n = 105) to those who had surgery ≥8 weeks (group B, n = 48) after neoadjuvant CRT. Results: Of 153 patients, 117 (76.5%) were male and 36 (23.5%) were female. Mean age was 57.8 years (range, 28 to 79 years). There was no difference in the rate of sphincter preserving surgery between the two groups (group A, 82.7% vs. group B, 77.6%; P = 0.509). The longer interval group had decreased postoperative complications, although statistical significance was not reached (group A, 28.8% vs. group B, 14.3%; P = 0.068). A total of 111 (group A, 75 [71.4%] and group B, 36 [75%]) patients were downstaged and 26 (group A, 17 [16.2%] and group B, 9 [18%]) achieved pathological complete response (pCR). There was no significant difference in the pCR rate (P = 0.817). The longer interval group experienced significant improvement in the nodal (N) downstaging rate (group A, 46.7% vs. group B, 66.7%; P = 0.024). The local recurrence (P = 0.279), distant recurrence (P = 0.427), disease-free survival (P = 0.967), and overall survival (P = 0.825) rates were not significantly different. Conclusion: It is worth delaying surgical resection for 8 weeks or more after completion of CRT as it is safe and is associated with higher nodal downstaging rates.

AB - Purpose: The optimal time between neoadjuvant chemoradiotherapy (CRT) and surgery for rectal cancer has been debated. This study evaluated the influence of this interval on oncological outcomes. Methods: We compared postoperative complications, pathological downstaging, disease recurrence, and survival in patients with locally advanced rectal cancer who underwent surgical resection ≥8 weeks (group A, n = 105) to those who had surgery ≥8 weeks (group B, n = 48) after neoadjuvant CRT. Results: Of 153 patients, 117 (76.5%) were male and 36 (23.5%) were female. Mean age was 57.8 years (range, 28 to 79 years). There was no difference in the rate of sphincter preserving surgery between the two groups (group A, 82.7% vs. group B, 77.6%; P = 0.509). The longer interval group had decreased postoperative complications, although statistical significance was not reached (group A, 28.8% vs. group B, 14.3%; P = 0.068). A total of 111 (group A, 75 [71.4%] and group B, 36 [75%]) patients were downstaged and 26 (group A, 17 [16.2%] and group B, 9 [18%]) achieved pathological complete response (pCR). There was no significant difference in the pCR rate (P = 0.817). The longer interval group experienced significant improvement in the nodal (N) downstaging rate (group A, 46.7% vs. group B, 66.7%; P = 0.024). The local recurrence (P = 0.279), distant recurrence (P = 0.427), disease-free survival (P = 0.967), and overall survival (P = 0.825) rates were not significantly different. Conclusion: It is worth delaying surgical resection for 8 weeks or more after completion of CRT as it is safe and is associated with higher nodal downstaging rates.

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