Arman Erkan1, Alvaro Mendez2, Maude Trepanier3, Justin Kelly2, George Nassif2, Matthew R Albert2, Lawrence Lee3, John R T Monson2. 1. Surgical Health Outcomes Consortium, Center for Colon and Rectal Surgery, AdventHealth, Orlando, FL. Electronic address: arman.erkan.md@adventhealth.com. 2. Surgical Health Outcomes Consortium, Center for Colon and Rectal Surgery, AdventHealth, Orlando, FL. 3. Surgical Health Outcomes Consortium, Center for Colon and Rectal Surgery, AdventHealth, Orlando, FL; Section of Colon and Rectal Surgery, Department of Surgery, McGill University Health Centre, Montreal, Quebec.
Abstract
BACKGROUND: The management of patients with a complete clinical response after neoadjuvant therapy for rectal adenocarcinoma is controversial. Those who advocate for resection point out the inaccuracy of N-staging with current imaging modalities. The objective of this study is to determine the impact of residual nodal involvement after complete tumor regression after neoadjuvant (chemo)radiotherapy. METHODS: The 2004 to 2014 National Cancer Database was queried for patients undergoing proctectomy for nonmetastatic rectal adenocarcinoma who had received neoadjuvant (chemo)radiotherapy and with ypT0 on final pathology. Patients were grouped based on pathologic nodal stage: ypT0N- and ypT0N+. The main outcome was 5-year overall survival. RESULTS: There were 5,156 patients with ypT0N- and 527 with ypT0N+. Mean lymph node harvest was similar (ypT0N- 12.2 nodes [standard deviation 9.1] vs ypT0N+ 11.6 nodes [standard deviation 10.3]; P = .086). Patients with ypT0N+ were more likely to have had clinically involved nodes (P < .001) and earlier clinical T-stage (P = .002). Overall survival at 5 years was less for patients with ypT0N+ (80% vs 86%, log-rank P = .014). ypT0N+ was independently associated with worse overall survival (hazard ratio 1.74, 95% confidence interval 1.33-2.28). CONCLUSION: Residual nodal involvement despite complete tumor regression was associated with worse 5-year overall survival compared to complete pathologic response. Additional therapy should be considered in the presence of complete clinical tumor regression after neoadjuvant (chemo)radiotherapy.
BACKGROUND: The management of patients with a complete clinical response after neoadjuvant therapy for rectal adenocarcinoma is controversial. Those who advocate for resection point out the inaccuracy of N-staging with current imaging modalities. The objective of this study is to determine the impact of residual nodal involvement after complete tumor regression after neoadjuvant (chemo)radiotherapy. METHODS: The 2004 to 2014 National Cancer Database was queried for patients undergoing proctectomy for nonmetastatic rectal adenocarcinoma who had received neoadjuvant (chemo)radiotherapy and with ypT0 on final pathology. Patients were grouped based on pathologic nodal stage: ypT0N- and ypT0N+. The main outcome was 5-year overall survival. RESULTS: There were 5,156 patients with ypT0N- and 527 with ypT0N+. Mean lymph node harvest was similar (ypT0N- 12.2 nodes [standard deviation 9.1] vs ypT0N+ 11.6 nodes [standard deviation 10.3]; P = .086). Patients with ypT0N+ were more likely to have had clinically involved nodes (P < .001) and earlier clinical T-stage (P = .002). Overall survival at 5 years was less for patients with ypT0N+ (80% vs 86%, log-rank P = .014). ypT0N+ was independently associated with worse overall survival (hazard ratio 1.74, 95% confidence interval 1.33-2.28). CONCLUSION: Residual nodal involvement despite complete tumor regression was associated with worse 5-year overall survival compared to complete pathologic response. Additional therapy should be considered in the presence of complete clinical tumor regression after neoadjuvant (chemo)radiotherapy.
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
Authors: Paola Germani; Francesca Di Candido; Daniel Léonard; Dajana Cuicchi; Ugo Elmore; Marco Ettore Allaix; Vittoria Pia Barbieri; Laura D'Allens; Seraina Faes; Marika Milani; Damiano Caputo; Carmen Martinez; Jan Grosek; Valerio Caracino; Niki Christou; Sapho X Roodbeen; Umberto Bracale; Aurelia Wildeboer; Antonella Usai; Michele Benedetti; Alessandro Balani; Giuseppe Piccinni; Marco Catarci; Paolo Millo; Nicole Bouvy; Francesco Corcione; Roel Hompes; Frédéric Ris; Massimo Basti; Ales Tomazic; Eduardo Targarona; Alessandro Coppola; Andrea Pietrabissa; Dieter Hahnloser; Michel Adamina; Massimo Viola; Mario Morino; Riccardo Rosati; Gilberto Poggioli; Alex Kartheuser; Antonino Spinelli; Nicolò de Manzini Journal: Updates Surg Date: 2021-04-05