<p>Short-Term Clinical and Oncological Outcome of Prolonging Operation Interval After Neoadjuvant Chemoradiotherapy for Locally Advanced Middle and Low Rectal Cancer</p>

Abstract

The purpose of this study is to evaluate the short-term clinical and oncological outcome of prolonging operation interval to 11 weeks after the end of radiotherapy for locally advanced middle and low rectal cancer. Methods: A total of 123 patients with stage II/III (cT3/T4 or N+) low and middle rectal cancer who had undergone operation after neoadjuvant chemoradiotherapy were selected. According to the interval time between the last radiotherapy and operation, they were assigned to a short-interval group (SG, <11 weeks, n=66) and long-interval group (LG, ≥11 weeks, n=57). The relations among interval time and short-term clinical outcome and oncological outcome were analyzed. Results: The analysis found that basic information, clinical characteristics, and preoperative treatment between the two groups had no significant difference. There were no differences in operation time, estimated intraoperative blood loss and postoperative complications. The rate of sphincter preservation in the low and middle rectum was 66.7% in the short-interval group and 59.7% in the long-interval group (P=0.42). The incidence of anastomotic leak in the long-interval group was higher than that in the short-interval group (P=0.08). There was no significant difference in the recovery time of intestinal function and median duration of hospitalization between the two groups. The pathological complete remission rate was 17.07%. Multivariate analysis showed interval time had no influence on pathological complete remission. There was no significant difference in 3-year overall survival and 3-year disease-free survival between the two groups. The risk of recurrence and metastasis in patients with positive lymph nodes was higher than those with negative lymph nodes (P<0.05), HR=4.812 (95% CI 2.4-9.648). Conclusion: Prolonging the interval time of operation to 11 weeks after neoadjuvant chemoradiotherapy for middle and low rectal cancer does not improve the pathologic complete remission, morbidity, and mortality. There was no significant effect on oncologic outcome after prolonging the operation interval. Therefore, it is safe to prolong the interval of operation to 11 weeks.

Determining the optimal radiation‐surgery interval (RSI) for oncologic proctectomy following radiotherapy for rectal adenocarcinoma

“…Most of the retrospective studies already cited in this review have not reported a difference in perioperative outcomes or surrogate markers for a challenging operation (e.g., OR time, estimated blood loss [EBL]), however, the differences between short and long RSI in many of these studies are typically measured in weeks and do not reflect operating on patients 1-2 years following radiation. 30,34,37,38,[40][41][42][43] that a longer interval before surgery did increase operative time and EBL, but this was only true in the group who received TNT followed by proctectomy in the Xu study. 35,67 However, Huntington and colleagues analyzed over 6300 patients from the National Cancer Database and found that patients with an RSI > 80 days were associated with higher rates of positive surgical margins and lower rates of sphincter preservation and survival, even after adjusting for potential confounding factors.…”

“…[29][30][31][32][33][34][35][36] Conversely, several other observational studies demonstrated that RSI length did not impact rates of pCR. [37][38][39][40][41][42][43][44] While well-intended, observational studies are subject to confounding variables that may obfuscate the effects of the RSI.…”

“…29,35 Conversely, four of the previously cited observational studies found no difference in OS or DFS among the RSI cohorts. 39,40,42,43 Trial data showed mixed impact of the effects of RSI on oncological outcomes. The Lyon R-90 trial, which randomized patients to short (2 weeks) or long (6-8 weeks) RSI showed no difference in OS or local recurrence.…”

Prediction of cancer-specific survival and overall survival in middle-aged and older patients with rectal adenocarcinoma using a nomogram model

“…Lymph node dissection is the focus of surgery, and the prognostic survival of patients is closely related to the degree of lymph node dissection [24] . An increased number of positive lymph nodes often indicates a high chance of recurrence and metastasis and a poor prognosis [25] . The AJCC proposes that the detection of ≥12 lymph nodes can improve the accuracy of postoperative staging of colorectal cancer and help determine the presence or absence of lymph node metastasis [26] .…”

Intra-arterial chemoembolization with chemotherapy for unresectable locally advanced rectal cancer: a case report and literature review

“…According to the latest global statistics, there were over 700,000 new cases and over 300,000 deaths in 2020 (1). Due to the lack of obvious symptoms in the preliminary stage, a great number of patients are already at clinical stage II and III when they are first diagnosed, which is defined as locally advanced rectal cancer (LARC) (2). For LARC, the standard treatment is neoadjuvant chemoradiotherapy and total mesorectal excision (TME), followed by postoperative adjuvant chemotherapy (3).…”