Highlights Diaphragmatic injuries are rare complications from trauma. Bilateral diaphragmatic injuries are extremely rare and just a few cases are reported. Sometimes the diagnosis is delayed or even missed. Both primary repair or mesh repair are safe and feasible. The use of a polypropylene mesh with titanized surface has not been attempted before.

Background: Colorectal cancer causes many deaths worldwide, with rectal cancer being responsible for a third of these mortalities. Surgical mesorectal excision along with preoperative neoadjuvant chemoradiotherapy is known as the standard treatment for rectal cancer. However, inaccurate preoperative staging is a main concern as it leads to a large number of patients not being treated with neoadjuvant therapy. Selection of the best treatment approach for these patients is controversial. Although some studies indicate significantly higher survival in patients who had received postoperative adjuvant chemoradiation compared with patients who had been treated with surgery alone, other studies have not found such results. Due to these contradictory findings, this study was designed to further evaluate the survival outcomes in rectal cancer patients who had received adjuvant chemoradiotherapy without neoadjuvant therapy. Methods: Totally, 197 rectal cancer patients who had received adjuvant chemoradiation were included in this study. The demographic and clinico-pathological characteristics of the patients were evaluated by statistical analysis. Results: Based on the univariate cox regression, poor disease free survival (DFS) was significantly associated with male sex and T3 stage. Poor overall survival (OS) was also associated with stage II/III, T3/T4, NI/NII, grade II/III, positive node number (>3), perineural invasion, lymphovascular invasion, and margin involvement. According to the multivariate cox regression, independent predictive factors for DFS were T3 and T4 stage; predictors for OS were T3/T4 stage, grade II/III, and lymphovascular invasion. Conclusion: Taken together, the obtained results indicate that combined adjuvant chemoradiation contributes to improve survival outcomes in rectal cancer patients who do not receive neoadjuvant therapy.