Neoadjuvant chemoradiotherapy for borderline resectable low rectal cancer: short- and long-term outcomes at a single Japanese center

Abstract PurposeExtralevator (ELAPE) and abdominoperineal excision (APE) are two major surgical approaches for low rectal cancer patients. Although excellent short-term efficacy is achieved in patients undergoing ELAPE, the long-term benefits have not been established. In this study we compared the survival outcomes in low rectal cancer patients who underwent ELAPE and APE.MethodsOne hundred fourteen patients were enrolled, including 68 in the ELAPE group and 46 in the APE group at the Beijing Chaoyang Hospital, Capital Medical University from January 2011 to December 2018. The baseline characteristics, overall survival (OS), progression-free survival (PFS), and local recurrence-free survival (LRFS) were calculated and compared between the two groups.ResultsDemographics and tumor stage were comparable between the two groups. The 5-year PFS (67.2 per cent versus 38.6 per cent, log-rank P = 0.008) and LRFS (87.0 per cent versus 62.3 per cent, log-rank P = 0.047) were significantly improved in the ELAPE group compared to the APE group, and the survival advantage was especially reflected in patients with pT3 tumors, positive lymph nodes or even those who have not received neoadjuvant chemoradiotherapy. Multivariate analysis showed that APE was an independent risk factor for OS (hazard ratio 3.000, 95 per cent c.i. 1.171 to 4.970, P = 0.004) and PFS (hazard ratio 2.730, 95 per cent c.i. 1.506 to 4.984, P = 0.001).Conclusion Compared with APE, ELAPE improved long-term outcomes for low rectal cancer patients, especially among patients with pT3 tumors, positive lymph nodes or those without neoadjuvant chemoradiotherapy.

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Does Conversion to Open of Laparoscopically Attempted Rectal Cancer Cases Affect Short- and Long-Term Outcomes? A Systematic Review and Meta-Analysis

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2017.0112 ◽

2018 ◽

Vol 28 (2) ◽

pp. 117-126 ◽

Cited By ~ 10

Author(s):

Nikolaos Gouvas ◽

Panagiotis A. Georgiou ◽

Christos Agalianos ◽

Georgios Tzovaras ◽

Paris Tekkis ◽

...

Keyword(s):

Systematic Review ◽

Rectal Cancer ◽

Meta Analysis ◽

Long Term Outcomes ◽

Short And Long Term

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Robotic versus laparoscopic sphincter-saving total mesorectal excision for mid or low rectal cancer in male patients after neoadjuvant chemoradiation therapy: comparison of long-term outcomes

Journal of Robotic Surgery ◽

10.1007/s11701-019-01001-5 ◽

2019 ◽

Vol 14 (3) ◽

pp. 393-399 ◽

Cited By ~ 3

Author(s):

Oktar Asoglu ◽

Handan Tokmak ◽

Baris Bakir ◽

Vusal Aliyev ◽

Sezer Saglam ◽

...

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Neoadjuvant Chemoradiation ◽

Chemoradiation Therapy ◽

Low Rectal Cancer ◽

Mesorectal Excision ◽

Long Term Outcomes ◽

Sphincter Saving ◽

Male Patients

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J-pouch vs. side-to-end anastomosis after hand-assisted laparoscopic low anterior resection for rectal cancer: A prospective randomized trial on short and long term outcomes including life quality and functional results

International Journal of Surgery ◽

10.1016/j.ijsu.2017.09.012 ◽

2017 ◽

Vol 47 ◽

pp. 4-12 ◽

Cited By ~ 2

Author(s):

Nuri Okkabaz ◽

Mustafa Haksal ◽

Ali Emre Atici ◽

Yunus Emre Altuntas ◽

Ersin Gundogan ◽

...

Keyword(s):

Rectal Cancer ◽

Randomized Trial ◽

Anterior Resection ◽

Low Anterior Resection ◽

Life Quality ◽

Functional Results ◽

Long Term Outcomes ◽

J Pouch ◽

Short And Long Term

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Neoadjuvant chemoradiotherapy for locally advanced rectal cancer: Predicting long-term outcomes based on response to treatment.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.621 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 621-621

Author(s):

Kirsten Elizabeth Jean Laws ◽

Christina Wilson ◽

David McIntosh ◽

Stephen Harrow

Keyword(s):

Rectal Cancer ◽

Locally Advanced ◽

Preoperative Staging ◽

Neoadjuvant Treatment ◽

Neoadjuvant Chemoradiotherapy ◽

Combined Modality Treatment ◽

Long Term Outcomes ◽

Node Positive ◽

Long Course

621 Background: Neoadjuvant long course chemoradiotherapy is well recognised as a standard treatment in locally advanced, margin threatening rectal cancer, in order to downstage and reduce local recurrence. We investigated retrospectively whether long term outcomes could be predicted by response to neoadjuvant treatment, and which factors specifically seemed to predict a risk of poorer outcome. Methods: All patients treated with long course chemoradiotherapy between January 2008 and December 2009 were identified retrospectively. Patients were excluded if the treatment indication was for inoperable disease, postoperative, recurrence, or palliative intent. A total of 231 patients were analysed with retrospective analysis of all electronic records and case notes. The following information was collated: preoperative staging, chemoradiotherapy treatment planned and received, operation performed, postoperative pathology (including nodal status, margins, presence of LVSI, and evidence of response to neoadjuvant treatment), disease free survival, and overall survival. Results: Kaplan Meier curves are presented showing patients with either a complete or partial response to neoadjuvant treatment appear to have a statistically significant improvement in long term outcomes, compared to those with no response (Mean survival 55 months, 56 months and 43months respectively, p<0.01). Furthermore, those who remain node positive or have evidence of LVSI following neoadjuvant treatment appear to have a statistically significant poorer outcome. Conclusions: Our study further develops on previous work looking at the prediction of outcomes following response to neoadjuvant treatment in rectal cancer. It appears that those who respond to initial treatment will have a better outcome than those who do not, including those who remain node positive or with LVSI following treatment. This study is limited because it is retrospective. Randomised controlled trial data is required to enable identification of poor risk imaging and pathology features that might suggest the need for adjuvant therapy following combined modality treatment with neoadjuvant chemoradiotherapy and surgery.

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