The assessment of risk factors for long-term survival outcome in ypN0 patients with rectal cancer after neoadjuvant therapy and radical anterior resection

Abstract

Background The main negative prognostic factors in patients with rectal cancer after radical treatment include regional lymph node involvement, lymphovascular invasion, and perineural invasion. However, some patients still develop cancer recurrence despite the absence of the above risk factors. The aim of the study was to assess clinicopathological factors influencing long-term oncologic outcomes in ypN0M0 rectal cancer patients after neoadjuvant therapy and radical anterior resection. Methods A retrospective survival analysis was performed on a group of 195 patients. We assessed clinicopathological factors which included tumor regression grade, number of lymph nodes in the specimen, Charlson comorbidity index (CCI), and colorectal anastomotic leakage (AL). Results In the univariate analysis, AL and CCI > 3 had a significant negative impact on disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). After the division of ALs into early and late ALs, it was found that only patients with late ALs had a significantly worse survival. The multivariate Cox regression analysis showed that CCI > 3 was a significant adverse risk factor for DFS (HR 5.78, 95% CI 2.15–15.51, p < 0.001), DSS (HR 7.25, 95% CI 2.25–23.39, p < 0.001), and OS (HR 3.9, 95% CI 1.72–8.85, p = 0.001). Similarly, late ALs had a significant negative impact on the risk of DFS (HR 5.05, 95% CI 1.97–12.93, p < 0.001), DSS (HR 10.84, 95% CI 3.44–34.18, p < 0.001), and OS (HR 4.3, 95% CI 1.94–9.53, p < 0.001). Conclusions Late AL and CCI > 3 are the factors that may have an impact on long-term oncologic outcomes. The impact of lymph node yield on understaging was not demonstrated.

Robotic versus Laparoscopic Total Mesorectal Excision Surgery in Rectal Cancer: Analysis of Medium-Term Oncological Outcomes

“…Previous studies have demonstrated that major complications after colorectal cancer surgery have a negative impact on local recurrence and OS and DFS. [24][25][26] As reported in previous studies, 27 the L-TME group had a longer postoperative median hospital stay (7(5-13) days vs 6(5-10)days, P = .047) due to a higher incidence of major postoperative complications. In our institution, patients with resectable rectal cancer rarely receive radiotherapy or chemotherapy before surgery; patients with postoperative pathological stage II and III often receive adjuvant chemotherapy after discharge.…”

Correlation of Presacral Tumour Recurrence with Tumour Metastasis and Long-Term Tumour Recurrence Risk in Patients with Rectal Cancer

“…For patients meeting the surgical indications, surgical treatment is the main choice, and radical resection of RC is the only radical treatment for patients with RC at present [ 8 , 9 ]. However, according to the previous statistics, patients with RC still face the risk of local recurrence after surgery.…”

Development and validation of a nomogram to predict the risk factors of major complications after radical rectal cancer surgery

“…In recent years, anastomosis and surgical techniques have developed considerably, but the incidence of post-operative complications in RC has not been significantly reduced (9)(10)(11)(12). Several previous studies have shown that post-operative complications affected the prognosis of RC (28-30).…”

“…In recent years, anastomotic devices and surgical techniques have improved considerably, however, the incidence of complications has not decreased significantly (9)(10)(11)(12). Many previous randomized controlled studies have explored the risk factors for post-operative complications in RC, including age (13), pre-operative albumin (14), pre-operative neoadjuvant therapy (15) and body mass index (BMI) (16).…”