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Modified short-course radiotherapy combined with chemoradiosensitizer is a feasible approach for treating T3 rectal cancer. With the use of the short-course approach, efforts to reduce the incidence of side effects by appropriately prolonging the waiting period enable the administration of combination treatment with short-course radiotherapy and chemotherapy.

BackgroundExtramural tumor deposits (TDs) and extracapsular lymph node involvement (ECLNI) are considered to be poor prognostic factors in patients with T3–4, N0–2, M0 colorectal cancer (CRC). Although TDs are known to have multiple origins and pleomorphic features, the prognostic significances of the different type of TDs have not yet been established.MethodsWe performed a retrospective review of 385 consecutive patients with T3–4, N0–2, M0 CRC who received curative resection at our institution between 2006 and 2012. We classified the TDs into two groups: invasive-type TD (iTD), which is characterized by the presence of lymphatic invasion, vascular invasion, perineural invasion, or undefined cancer cell clusters and nodular-type TD (nTD), which is characterized by a smooth or irregular-shaped tumor nodule other than an iTD. ECLNI was defined as invasion of cancer cells into capsular collagen tissues or adipose tissues beyond the capsular collagen. Multivariate analyses were used to assess the prognostic significance of iTD, ND, and ECLNI for relapse-free survival (RFS), disease-specific survival (DSS), and sites of recurrence.ResultsIn patients without lymph node (LN) metastasis, the incidences of iTD and nTD were both in the range of 2–3 %. Conversely, in patients with LN metastasis, the incidences of iTD, nTD, and ECLNI were 31, 22, and 34 %, respectively. iTD, nTD, and ECLNI were all significant independent adverse factors for RFS in rectal cancer, and were all associated with pT, pN, and LN ratio. iTD was a significant independent adverse prognostic factor for DSS in rectal cancer, metastasis to the liver in colorectal cancer, and distant LN metastasis in colon cancer. ECLNI was a significant independent prognostic factor for RFS in colon cancer.ConclusionsClassifying TDs and assessing ECLNI may help establish significant prognostic factors for patients with T3–4, N0–2, M0 CRC.

Aims: To compare the long-term functional outcomes of total mesorectal excision following chemoradiotherapy for lower rectal cancer between stapled anastomosis and intersphincteric resection (ISR). Methods: A total of 105 of 170 sphincter-preserving patients found to be disease-free and anal functional patients were assessed at 6.5 years (range 2.4-13.0 years) of follow-up after surgery. Of these subjects, 87 (double stapling technique [DST]: 41; ISR: 46) of the 105 patients (82.9%) responded to the questionnaire on the low anterior resection syndrome score (LARS score). Results: The total LARS scores in the DST and ISR groups were not significantly different (Major/Minor/No LARS = 23/14/4 and 31/10/5, p = 0.431). When considering each item of the LARS, ISR was associated with poorer incontinence scores than DST. Conversely, the scores for the frequency of bowel movement, clustering and urgency were not different between the 2 groups. In addition, in the multivariate analysis, the tumor distance from the anal verge and postoperative period was independently associated with Major LARS. Conclusion: In this study, we demonstrate the long-term functional outcomes of irradiated lower rectal cancer reconstructed with DST and ISR. Bowel function improves over time; therefore, long-term patient follow-up is important.

PurposeThis study assessed the incidence of malnutrition caused by preoperative chemoradiotherapy (CRT) in rectal cancer patients, which is seemingly underestimated; however, malnutrition affects treatment tolerability, postoperative complications, including anastomotic leakage (AL), and oncological outcomes.MethodsBetween January 2008 and December 2014, 54 consecutive patients with T3–4, N0–2, M0–1 resectable rectal cancer received CRT comprising 45 Gy radiotherapy and S-1 alone or with irinotecan for 5 weeks and then underwent curative surgery with diverting or permanent stomas 6–8 weeks after CRT. We assessed malnutrition after completion of CRT (5–6 weeks after CRT start date) and at surgery (11–14 weeks after CRT start date), defining weight loss as ≥5 % of pre-CRT weight; this definition differs from commonly used criteria for adverse events. We evaluated the incidence of malnutrition associated with CRT and influence of malnutrition on treatment tolerability, AL, and disease-free survival (DFS). We also assessed the influence of CRT on the rate of postoperative complications by comparing the study group with 61 patients who had undergone excision with diverting or permanent stomas alone.ResultsMalnutrition was observed in 51 % of patients after CRT and in 29 % at surgery. Malnutrition after CRT was associated with treatment tolerability, and malnutrition at surgery was significantly associated with AL, which significantly influenced DFS in stage 1–3 patients.ConclusionMalnutrition caused by CRT is common and is associated with treatment tolerability and AL. Nutritional assessment and support seem indispensable for the rectal cancer patients receiving CRT.