Olivier Muller1, Remy Sindayigaya1, Sandra Chomicki1, Elias Karam1, Nicolas Tabchouri1, Nicolas Michot1, Driffa Moussata2, Thierry Lecomte2, Sophie Chapet3, Gilles Calais3, Urs Giger-Pabst4,5, Ephrem Salame1, Mehdi Ouaissi6. 1. Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France. 2. Department of Hepatogastroenterology and Digestive Oncology, Trousseau Hospital, Tours, France. 3. Department of Radiotherapy, Bretonneau Hospital, Tours, France. 4. EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France. 5. University of Applied Science Düsseldorf, Düsseldorf, Germany. 6. Department of Digestive, Oncological, Endocrine, Hepato-Biliary, Pancreatic and Liver Transplant Surgery, Trousseau Hospital, Chambray Les Tours, France m.ouaissi@chu-tours.fr.
Abstract
BACKGROUND/AIM: Impact of neoadjuvant chemoradiotherapy (CRT) in locally advanced upper rectal adenocarcinoma (LAURC) is debated. The aim of this study was to compare outcomes between LAURC and locally advanced sigmoid and recto-sigmoid junction cancer (LASC). PATIENTS AND METHODS: This retrospective study included 149 consecutive patients [42 CRT/LAURC, 16 upfront surgery (US/LAURC) and 91 LASC]. Partial mesorectum excision (PME) was performed for all LAURC. Pathology results as well as short-and-long-term outcomes were compared between the three groups. RESULTS: Overall mortality was nil. Morbidity was comparable (CRT/LAURC 23.8% vs. LASC: 20.8% vs. US/LAURC: 37.5%, p=0.2354). CRT was associated with a reduced risk of positive circumferential margin (CRT/LAURC: 9.5% vs. US/LAURC: 18.7%, p<0.0001). Recurrence rate, 5-year disease-free survival and overall survival were similar between the three groups. CONCLUSION: CRT and PME did not improve LAURC oncological outcomes but were associated with improved margins. CRT for LAURC was not associated with increased morbidity.
BACKGROUND/AIM: Impact of neoadjuvant chemoradiotherapy (CRT) in locally advanced upper rectal adenocarcinoma (LAURC) is debated. The aim of this study was to compare outcomes between LAURC and locally advanced sigmoid and recto-sigmoid junction cancer (LASC). PATIENTS AND METHODS: This retrospective study included 149 consecutive patients [42 CRT/LAURC, 16 upfront surgery (US/LAURC) and 91 LASC]. Partial mesorectum excision (PME) was performed for all LAURC. Pathology results as well as short-and-long-term outcomes were compared between the three groups. RESULTS: Overall mortality was nil. Morbidity was comparable (CRT/LAURC 23.8% vs. LASC: 20.8% vs. US/LAURC: 37.5%, p=0.2354). CRT was associated with a reduced risk of positive circumferential margin (CRT/LAURC: 9.5% vs. US/LAURC: 18.7%, p<0.0001). Recurrence rate, 5-year disease-free survival and overall survival were similar between the three groups. CONCLUSION: CRT and PME did not improve LAURC oncological outcomes but were associated with improved margins. CRT for LAURC was not associated with increased morbidity.