PURPOSE: The optimal waiting period between neoadjuvant treatment completion and surgery in locally advanced rectal cancer (LARC) is controversial. The specific purpose of this study was to evaluate the effect of prolonging this interval on the pathologic response, postoperative morbidity, and long-term oncologic outcomes. METHODS: Retrospective data analysis is reported from LARC patients who had been treated with chemoradiation followed by surgery and intra-operative radiotherapy, between February 1995 and December 2012. In total, two groups were studied, according to the time elapsed between neoadjuvant treatment and surgery: conventional interval (CI; <6 weeks) and delayed interval (DI; ≥6 weeks). Clinicopathological data related to tumor response, postoperative morbidity, and oncologic outcomes were compared. RESULTS: This study included 335 consecutive LARC patients. There was a higher proportion of patients with clinical staging nodal involvement (cN+) in the DI group (76.6 vs. 64.1 %; p = 0.01). The pathologic complete response (pCR) was not significantly different among groups (8.8 vs. 12.1 %; p = 0.34). Longer intervals did not affect complication incidence or severity or hospital admission length. Certain postneoadjuvant tumor effect parameters were significantly increased in the DI group, including N-downstaging and T-downsizing. After a median follow-up of 71 months, patients in the DI group presented with superior 5-year overall survival (OS) (55.9 vs. 70.4 %, p = 0.014); however, no statistically significant differences were observed in 5-year disease-free survival (DFS) or 5-year local control (LC) (69.9 vs. 74.9 %, p = 0.223; 90.4 vs. 94.5 %, p = 0.123, respectively). CONCLUSIONS: A modest surgical interval delay (≥6 weeks) did not increase postoperative complications and was identified as a favorable prognostic factor for OS, although no differences were observed in pCR, LC, or DFS. Innovative multidisciplinary strategies incorporating further time extension of the surgical interval can be safely explored.
PURPOSE: The optimal waiting period between neoadjuvant treatment completion and surgery in locally advanced rectal cancer (LARC) is controversial. The specific purpose of this study was to evaluate the effect of prolonging this interval on the pathologic response, postoperative morbidity, and long-term oncologic outcomes. METHODS: Retrospective data analysis is reported from LARC patients who had been treated with chemoradiation followed by surgery and intra-operative radiotherapy, between February 1995 and December 2012. In total, two groups were studied, according to the time elapsed between neoadjuvant treatment and surgery: conventional interval (CI; <6 weeks) and delayed interval (DI; ≥6 weeks). Clinicopathological data related to tumor response, postoperative morbidity, and oncologic outcomes were compared. RESULTS: This study included 335 consecutive LARC patients. There was a higher proportion of patients with clinical staging nodal involvement (cN+) in the DI group (76.6 vs. 64.1 %; p = 0.01). The pathologic complete response (pCR) was not significantly different among groups (8.8 vs. 12.1 %; p = 0.34). Longer intervals did not affect complication incidence or severity or hospital admission length. Certain postneoadjuvant tumor effect parameters were significantly increased in the DI group, including N-downstaging and T-downsizing. After a median follow-up of 71 months, patients in the DI group presented with superior 5-year overall survival (OS) (55.9 vs. 70.4 %, p = 0.014); however, no statistically significant differences were observed in 5-year disease-free survival (DFS) or 5-year local control (LC) (69.9 vs. 74.9 %, p = 0.223; 90.4 vs. 94.5 %, p = 0.123, respectively). CONCLUSIONS: A modest surgical interval delay (≥6 weeks) did not increase postoperative complications and was identified as a favorable prognostic factor for OS, although no differences were observed in pCR, LC, or DFS. Innovative multidisciplinary strategies incorporating further time extension of the surgical interval can be safely explored.
Authors: David E Stein; Najjia N Mahmoud; Pramila Rani Anné; Deborah G Rose; Gerald A Isenberg; Scott D Goldstein; Edith Mitchell; Robert D Fry Journal: Dis Colon Rectum Date: 2003-04 Impact factor: 4.585
Authors: Luigi Zorcolo; Alan S Rosman; Angelo Restivo; Michele Pisano; Giuseppe R Nigri; Alessandro Fancellu; Marcovalerio Melis Journal: Ann Surg Oncol Date: 2012-03-21 Impact factor: 5.344
Authors: Luiz Felipe de Campos-Lobato; Daniel P Geisler; Andre da Luz Moreira; Luca Stocchi; David Dietz; Matthew F Kalady Journal: J Gastrointest Surg Date: 2010-12-08 Impact factor: 3.452
Authors: Mark S Roh; Linda H Colangelo; Michael J O'Connell; Greg Yothers; Melvin Deutsch; Carmen J Allegra; Morton S Kahlenberg; Luis Baez-Diaz; Carol S Ursiny; Nicholas J Petrelli; Norman Wolmark Journal: J Clin Oncol Date: 2009-09-21 Impact factor: 44.544
Authors: D A M Sloothaak; D E Geijsen; N J van Leersum; C J A Punt; C J Buskens; W A Bemelman; P J Tanis Journal: Br J Surg Date: 2013-03-27 Impact factor: 6.939
Authors: Matthew F Kalady; Luiz Felipe de Campos-Lobato; Luca Stocchi; Daniel P Geisler; David Dietz; Ian C Lavery; Victor W Fazio Journal: Ann Surg Date: 2009-10 Impact factor: 12.969
Authors: C M Dolinsky; N N Mahmoud; R Mick; W Sun; R W Whittington; L J Solin; D G Haller; B J Giantonio; P J O'Dwyer; E F Rosato; R D Fry; J M Metz Journal: J Surg Oncol Date: 2007-09-01 Impact factor: 3.454
Authors: A A F A Veenhof; R H J Kropman; A F Engel; M E Craanen; S Meijer; O W M Meijer; D L van der Peet; M A Cuesta Journal: Int J Colorectal Dis Date: 2006-09-29 Impact factor: 2.796
Authors: Julio Garcia-Aguilar; Oliver S Chow; David D Smith; Jorge E Marcet; Peter A Cataldo; Madhulika G Varma; Anjali S Kumar; Samuel Oommen; Theodore Coutsoftides; Steven R Hunt; Michael J Stamos; Charles A Ternent; Daniel O Herzig; Alessandro Fichera; Blase N Polite; David W Dietz; Sujata Patil; Karin Avila Journal: Lancet Oncol Date: 2015-07-14 Impact factor: 41.316
Authors: Oliver S Chow; Deborah Kuk; Metin Keskin; J Joshua Smith; Niedzica Camacho; Raphael Pelossof; Chin-Tung Chen; Zhenbin Chen; Karin Avila; Martin R Weiser; Michael F Berger; Sujata Patil; Emily Bergsland; Julio Garcia-Aguilar Journal: Ann Surg Oncol Date: 2016-03-28 Impact factor: 5.344
Authors: H E Haak; G L Beets; K Peeters; P J Nelemans; V Valentini; C Rödel; L Kuo; F A Calvo; J Garcia-Aguilar; R Glynne-Jones; S Pucciarelli; J Suarez; G Theodoropoulos; S Biondo; D M J Lambregts; R G H Beets-Tan; M Maas Journal: Br J Surg Date: 2021-10-23 Impact factor: 11.122