Does one size fit all? Risks and benefits of neoadjuvant chemoradiation in patients with clinical stage IIA rectal cancer requiring abdominoperineal resection

Mariane Gouvêa Monteiro de Camargo; Xhileta Xhaja; Alexandra Aiello; David Liska; Emre Gorgun; David W Dietz; Matthew F Kalady; Conor P Delaney; Scott R Steele; Michael A Valente

doi:10.1016/j.amjsurg.2019.10.037

Does one size fit all? Risks and benefits of neoadjuvant chemoradiation in patients with clinical stage IIA rectal cancer requiring abdominoperineal resection

Am J Surg. 2020 Mar;219(3):406-410. doi: 10.1016/j.amjsurg.2019.10.037. Epub 2019 Oct 23.

Authors

Affiliations

¹ Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A-30, Cleveland, OH, 44195, USA. Electronic address: mariane.monteiro@icloud.com.
² Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A-30, Cleveland, OH, 44195, USA. Electronic address: xhajax@ccf.org.
³ Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: aielloa@ccf.org.
⁴ Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A-30, Cleveland, OH, 44195, USA. Electronic address: liskad@ccf.org.
⁵ Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A-30, Cleveland, OH, 44195, USA. Electronic address: gorgune@ccf.org.
⁶ Division of Colorectal Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA. Electronic address: david.dietz@uhhospitals.org.
⁷ Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A-30, Cleveland, OH, 44195, USA. Electronic address: kaladym@ccf.org.
⁸ Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A-30, Cleveland, OH, 44195, USA. Electronic address: delanec@ccf.org.
⁹ Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A-30, Cleveland, OH, 44195, USA. Electronic address: steeles3@ccf.org.
¹⁰ Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A-30, Cleveland, OH, 44195, USA. Electronic address: valentm2@ccf.org.

PMID: 31672306
DOI: 10.1016/j.amjsurg.2019.10.037

Abstract

Background: Neoadjuvant chemoradiotherapy (nCRT) has become the standard of care for locally advanced rectal cancer, decreasing locoregional recurrence, yet with an unclear survival advantage. We aimed to assess the benefit of nCRT on oncologic and perioperative outcomes of patients with clinical stage IIA rectal adenocarcinoma treated with abdominoperineal resection (APR).

Methods: Patients with clinical T3N0 rectal adenocarcinoma that underwent APR between 1995 and 2014 were included. Patients who received nCRT were compared with patients who did not. Multivariate analysis was conducted to compare oncological and perioperative outcomes between the groups.

Results: 127 patients were included, of which 94 received nCRT. Median follow-up was 11.9 years. There was no difference in circumferential margins, postoperative morbidity, and complication rates between the groups. There was no difference in 5-year oncological outcomes between the groups.

Conclusions: No difference was found in 5-year oncological outcomes between patients with clinical T3N0 rectal adenocarcinoma necessitating an APR who received nCRT and those not receiving nCRT, with similar overall complication rates.

MeSH terms

Adenocarcinoma / mortality
Adenocarcinoma / pathology
Adenocarcinoma / therapy*
Aged
Chemoradiotherapy, Adjuvant*
Female
Humans
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Recurrence, Local
Neoplasm Staging
Postoperative Complications
Proctectomy*
Rectal Neoplasms / mortality
Rectal Neoplasms / pathology
Rectal Neoplasms / therapy*
Risk Assessment
Survival Analysis