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Short-Term Clinical and Oncological Outcome of Prolonging Operation Interval After Neoadjuvant Chemoradiotherapy for Locally Advanced Middle and Low Rectal Cancer

Authors Yang J, Chen Q, Li J, Song Z, Cheng Y

Received 14 January 2020

Accepted for publication 9 March 2020

Published 27 March 2020 Volume 2020:12 Pages 2315—2325


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Rudolph Navari

Jianguo Yang, Qingwei Chen, Jindou Li, Zhiyang Song, Yong Cheng

Department of Gastrointestinal Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China

Correspondence: Yong Cheng
Department of Gastrointestinal Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
Email Chengyongcq@163.Com

Purpose: The purpose of this study is to evaluate the short-term clinical and oncological outcome of prolonging operation interval to 11 weeks after the end of radiotherapy for locally advanced middle and low rectal cancer.
Methods: A total of  123 patients with stage II/III (cT3/T4 or N+) low and middle rectal cancer who had undergone operation after neoadjuvant chemoradiotherapy were selected. According to the interval time between the last radiotherapy and operation, they were assigned to a short-interval group (SG, < 11 weeks, n=66) and long-interval group (LG, ≥ 11 weeks, n=57). The relations among interval time and short-term clinical outcome and oncological outcome were analyzed.
Results: The analysis found that basic information, clinical characteristics, and preoperative treatment between the two groups had no significant difference. There were no differences in operation time, estimated intraoperative blood loss and postoperative complications. The rate of sphincter preservation in the low and middle rectum was 66.7% in the short-interval group and 59.7% in the long-interval group (P=0.42). The incidence of anastomotic leak in the long-interval group was higher than that in the short-interval group (P=0.08). There was no significant difference in the recovery time of intestinal function and median duration of hospitalization between the two groups. The pathological complete remission rate was 17.07%. Multivariate analysis showed interval time had no influence on pathological complete remission. There was no significant difference in 3-year overall survival and 3-year disease-free survival between the two groups. The risk of recurrence and metastasis in patients with positive lymph nodes was higher than those with negative lymph nodes (P< 0.05), HR=4.812 (95% CI 2.4– 9.648).
Conclusion: Prolonging the interval time of operation to 11 weeks after neoadjuvant chemoradiotherapy for middle and low rectal cancer does not improve the pathologic complete remission, morbidity, and mortality. There was no significant effect on oncologic outcome after prolonging the operation interval. Therefore, it is safe to prolong the interval of operation to 11 weeks.

Keywords: rectal cancer, neoadjuvant chemoradiotherapy, oncological outcome, clinical outcome, pathological complete remission

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