Perioperative Blood Transfusions are Associated with Worse Overall Survival but not Disease-Free Survival After Curative Rectal Cancer Resection

e14173 Background: Colorectal cancer is the second most common cancer with 2,4 million people diagnosed. The rectal cancer (RC) is 27% of these cases. Neoadjuvant chemoradiotherapy (NCRT) has become standard but brought controversy in the adjuvant treatment. The objective was to assess the impact of adjuvant chemotherapy after NCRT. Methods: Between mar/96 and Oct/2010, 84 patients received NCRT, and 58 patients underwent resection of the rectum. The NCRT consisted of 5-FU 350mg/m2, D1-D5 (50% of cases) or 5-FU 425mg/m2, D1-D3 (43%) with LV 20mg/m2 bolus in the 1st and 5th week of the 25 sessions of radiotherapy in linear accelerator (total 45 - 50 Gy). When performed, Adjuvant chemotherapy (ADJC) consisted of 5-FU 425mg/m2, LV 20mg/m2, both on D1-D5 for 4 cycles. Evaluation of Overall Survival (O.S) and Disease-Free Survival (DFS) performed using Kaplan-Meier curve in SPSS version 13.0 Results: Of the 58 patients who underwent surgery, 90% were stage II, 51% occurred in the lower rectum and 66% were ECOG 1. Pathologic Complete Response (PCR) was obtained in 25.8% (15) of patients (group 1). Of these, 20% (3) received ADJC. Patients without PCR (group 2) received ADJC in 51% of the cases (22). The mean follow-up was 41 months. Both the DFS (HR: 2.594, 95% CI: 1134-5938, p = 0.024) and OS (HR: 2.615, 95% CI: 1005-6807, p = 0.0488) were higher in patients with PCR independent of the use of ADJC. On the other hand, patient treated with ADJC vs without ADJC, independent of presence of PCR, did not alter DFS (p = 0.74) or OS (p = 0.32). In PCR patients, ADJC do not interfere in the outcome (DFS, p = 0.76; SG, p = 0.73). In group 2 (patients without PCR), the subgroup with ADJC, there was a trend towards better SLD (p = 0.06) and OS (p = 0.06). Those who did not receive ADJC in group 2 had worse SLD (p = 0.011) and OS (p = 0.028) compared with group-1. Conclusions: Adjuvant treatment after NCRT did not increase OS or DFS. Patients without PRC had worse results without ADJC, compared to those with PCR. The first, probably, the subgroup of patients who benefited most from the use of ADJC. PCR improves OS and DFS regardless of ADJC, being perhaps the group that does not deserve ADJC.

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Preoperative vs postoperative radiotherapy in the management of rectal cancer: A systematic review

Radioterapi & Onkologi Indonesia ◽

10.32532/jori.v12i1.125 ◽

2021 ◽

Vol 12 (1) ◽

pp. 17-23

Author(s):

Muhammad Fauzi Siregar

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Locoregional Recurrence ◽

Randomized Clinical Trials ◽

Preoperative Radiotherapy ◽

Postoperative Radiotherapy ◽

Disease Free Survival ◽

Free Survival ◽

Radiotherapy Group ◽

Disease Free

Purpose. The objective of this study is to review randomized clinical trials systematically that compare the outcomes of preoperative and postoperative radiotherapy in the management of rectal cancer regarding locoregional recurrance, disease free survival and overall survival.Methods. The relevant randomized clinical trials are searched via online databases such as Pubmed, Ebsco, and Proquest. RCTs publised in English between 2000 until 2020 are selected and reviewed systematically.Result. Locoregional recurrence at 5 years was statistically lower in preoperative radiotherapy group than in postoperative radiotherapy group based on two studies. Disease free survival at 5-years was statistically higher in preoprative radiotherapy group than the postoperative one based on two studies. Overall survival at 5 years was not statistically significant between two groups for each study.Conclusion. Preoperative radiotherapy is superior to postoperative radiotherapy for controlling locoregional recurrence and disease free survival, but both are equal in overall survival.

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Neoadjuvant chemoradiation for rectal cancer: A 5-year institutional experience at Sparrow Hospital

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.14601 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 14601-14601

Author(s):

G. Srkalovic ◽

R. A. Miranda ◽

M. Maier ◽

L. DiCarlo ◽

U. Chamarthy ◽

...

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Rectal Carcinoma ◽

Proportional Hazards ◽

Disease Free Survival ◽

Neoadjuvant Chemoradiation ◽

Cox Proportional Hazards ◽

Preoperative Chemoradiation ◽

Free Survival ◽

Disease Free

14601 Continued efforts to improve local control and to maximize sphincter preservation in patients with rectal carcinoma led to consideration of preoperative chemoradiation. The purpose of this retrospective study is to examine clinical outcomes and find out which prognostic factors are related to survival in patients treated with neoadjuvant chemoradiation in Sparrow Hospital from 1998–2003. Forty two patients with biopsy proven rectal carcinoma without evidence of extra pelvic spread were treated in this fashion. Radiation therapy was administered for a total dose of 5.00 cGy. Chemotherapy used was 5-FU in 37 patients, and in combination with leucovorin in additional 5 patients. Surgical treatments performed were abdominoperineal resection (23 pts), low anterior resection in 13 pts., transanal excisions (2 pts), 2 patients had only exploratory laparotomy and for 2 patients records were not available. Cox proportional hazards regression techniques were used to estimate survival rates. Univariate and multivariate Cox proportional hazards analyses were used to evaluate relationship between risk factors and the survival. The SAS system (V9.1.3, Cary NC) was used for all analyses. Out of 42 patients analyzed 25 were males and 17 females. Mean age was 65 years (range 31 - 85). Median follow-up time was 57 months with a range from 7 to 98 months. After the surgery 4 patients had complete response, 12 were stage I, 10 stage II, 12 patients stage III, one patient had metastatic disease and for 2 patients records were inadequate. Analysis of disease free survival showed actuarial 5-year disease free survival to be 59%. Actuarial 5-year overall survival was 67%. Median overall survival was still not reached, while median disease-free survival is 78 months . Univariate and multivariate analyses showed that only postoperative stage was associated significantly with overall survival. Specifically, there was an increase in the risk of mortality of just over 3-fold for each increment in post-operative stage. In conclusion, in the community settings preoperative chemoradiation seem to provide good overall and disease free survival for patients with rectal cancer. Postoperative stage appears to be the most important prognostic factor for the survival. No significant financial relationships to disclose.

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LONG-TERM OUTCOMES OF TRANSANAL TOTAL MESORECTAL EXCISION FOR RECTAL CANCER

British Journal of Surgery ◽

10.1093/bjs/znab160.018 ◽

2021 ◽

Vol 108 (Supplement_3) ◽

Author(s):

M Labalde Martínez ◽

A Vivas Lopez ◽

J Ocaña Jimenez ◽

O García Villar ◽

C Nevado García ◽

...

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Total Mesorectal Excision ◽

Functional Outcomes ◽

Survival Rates ◽

Disease Free Survival ◽

Transanal Total Mesorectal Excision ◽

Mesorectal Excision ◽

Free Survival ◽

Disease Free

Abstract INTRODUCTION Transanal total mesorectal excision (TaTME) for rectal cancer offers a better vision of the dissection planes and facilitates the distal transection of the rectum. The aim of this study was to compare functional outcomes, local recurrence rate y 2-years overall survival and disease free survival rates of TaTME and laparoscopic total mesorectal excision (LPC TME). MATERIAL AND METHODS From December 2016 to October 2018, 50 patients (36 males and 14 females) with low rectal cancer and an age of 67 (55.7-75.2) years underwent TME (20 TaTME and 30 LPCTME). RESULTS Clinical features and quality indicators for rectal cancer surgery were similar in both groups. After a median follow-up of 35 (30-40) months, low anterior resection syndrome rate was 14% (15% vs 13%, p = 0.043), fecal incontinence rate was 8% (15% vs 3%, p = 0.017) and sexual dysfunction was 8% (15% vs 3%, p = 0.017). Systemic recurrence rate was 10% (15% vs 6%, p = 0.377). One patient presented local recurrence 2 years after TATME. 2-years overall survival rate was 98% (95% vs 100%, p = 0.400) and 2-years disease free survival rate was 90 % (85% vs 93%, p = 0.377). CONCLUSION Although 2-years overall survival and disease free survival rates were similar in TaTME and LPC TME group, functional outcomes were worse after TATME in our study.

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mRNA quantitation of thymidylate synthase and dihydropyrimidine dehydrogenase can predict disease-free survival in stage IIb and III colon and stage II and III rectal cancer

Gastroenterology ◽

10.1016/s0016-5085(01)80313-9 ◽

2001 ◽

Vol 120 (5) ◽

pp. A63-A63

Author(s):

M KOMMANN ◽

K LINK ◽

W SCHWABE ◽

P HAEUSSLER ◽

J STRAETER ◽

...

Keyword(s):

Rectal Cancer ◽

Thymidylate Synthase ◽

Dihydropyrimidine Dehydrogenase ◽

Disease Free Survival ◽

Stage Ii ◽

Free Survival ◽

Mrna Quantitation ◽

Disease Free

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Comparison of clinical outcomes between enucleation and regular pancreatectomy in patients with non-functional pancreatic neuroendocrine tumors: a retrospective multicenter and propensity score-matched study

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa246 ◽

2021 ◽

Author(s):

Zhen Yang ◽

Hengjun Gao ◽

Jun Lu ◽

Zheyu Niu ◽

Huaqiang Zhu ◽

...

Keyword(s):

Overall Survival ◽

Postoperative Complications ◽

Propensity Score ◽

Propensity Score Matching ◽

Neuroendocrine Tumors ◽

Disease Free Survival ◽

Pancreatic Neuroendocrine Tumors ◽

Free Survival ◽

Estimated Blood Loss ◽

Disease Free

Abstract Objective There are limited data from retrospective studies on whether therapeutic outcomes after regular pancreatectomy are superior to those after enucleation in patients with small, peripheral and well-differentiated non-functional pancreatic neuroendocrine tumors. This study aimed to compare the short- and long-term outcomes of regular pancreatectomy and enucleation in patients with non-functional pancreatic neuroendocrine tumors. Methods Between January 2007 and July 2020, 227 patients with non-functional pancreatic neuroendocrine tumors who underwent either enucleation (n = 89) or regular pancreatectomy (n = 138) were included. Perioperative complications, disease-free survival, and overall survival probabilities were compared. Propensity score matching was performed to balance the baseline differences between the two groups. Results The median follow-up period was 60.76 months in the enucleation group and 43.29 months in the regular pancreatectomy group. In total, 34 paired patients were identified after propensity score matching. The average operative duration in the enucleation group was significantly shorter than that in the regular pancreatectomy group (147.94 ± 42.39 min versus 217.94 ± 74.60 min, P < 0.001), and the estimated blood loss was also significantly lesser (P < 0.001). The matched patients who underwent enucleation displayed a similar overall incidence of postoperative complications (P = 0.765), and a comparable length of hospital stay (11.12 ± 3.90 days versus 9.94 ± 2.62 days, P = 0.084) compared with those who underwent regular pancreatectomy. There were no statistically significant differences between the two groups in disease-free survival and overall survival after propensity score matching. Conclusion Enucleation in patients with non-functional pancreatic neuroendocrine tumors was associated with shorter operative time, lesser intraoperative bleeding, similar overall morbidity of postoperative complications, and comparable 5-year disease-free survival and overall survival when compared with regular pancreatectomy.

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