Does complete pathological response increase perioperative morbidity risk in rectal cancer?

Thomas K S Tiang; Adrian S S Yeoh; Bushra Othman; Helen M Mohan; Adele N Burgess; Philip J Smart; David M Proud

doi:10.1111/codi.16939

Does complete pathological response increase perioperative morbidity risk in rectal cancer?

Colorectal Dis. 2024 Mar 11. doi: 10.1111/codi.16939. Online ahead of print.

Authors

Thomas K S Tiang¹, Adrian S S Yeoh¹, Bushra Othman², Helen M Mohan², Adele N Burgess¹, Philip J Smart¹, David M Proud¹

Affiliations

¹ Colorectal Surgery, Austin Health, Heidelberg, Victoria, Australia.
² Department of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.

PMID: 38467575
DOI: 10.1111/codi.16939

Abstract

Aim: The optimal management of patients with clinical complete response after neoadjuvant treatment for rectal cancer is controversial. The aim of this study is to compare the morbidity between patients with locally advanced rectal cancer who have had a pathological complete response (pCR) or not after neoadjuvant chemoradiotherapy (NCRT) and total mesorectal excision (TME). The study hypothesis was that pCR may impact the surgical complication rate.

Method: A retrospective cohort study was conducted of a prospectively maintained database in Australia and New Zealand, the Binational Colorectal Cancer Audit, that identified patients with locally advanced rectal cancer (<15 cm from anal verge) from 1 January 2007 to 31 December 2019. Patients were included if they had locally advanced rectal cancer and had undergone NCRT and proceeded to surgical resection.

Results: There were 4584 patients who satisfied the inclusion criteria, 65% being male. The mean age was 63 years and 11% had a pCR (ypT0N0). TME with anastomosis was performed in 67.8% of patients, and the majority of the cohort received long-course radiotherapy (81.7%). Both major and minor complications were higher in the TME without anastomosis group (17.3% vs. 14.7% and 30.6% vs. 20.8%, respectively), and the 30-day mortality was 1.31%. In the TME with anastomosis group, pCR did not contribute to higher rates of surgical complications, but male gender (p < 0.0012), age (p < 0.0001), preoperative N stage (p = 0.0092) and American Society of Anesthesologists (ASA) score ≥3 (p < 0.0002) did. In addition, pCR had no significant effect (p = 0.44) but male gender (p = 0.0047) and interval to surgery (p = 0.015) contributed to higher rates of anastomotic leak. In the TME without anastomosis cohort, the only variable that contributed to higher rates of complications was ASA score ≥3 (p = 0.033).

Conclusion: Patients undergoing TME dissection for rectal cancer following NCRT showed no difference in complications whether they had achieved pCR or not.

Keywords: complete pathological response; radiochemotherapy; rectal cancer; total mesorectal excision.