Impact of Delaying Surgery After Chemoradiation in Rectal Cancer: Outcomes From a Tertiary Cancer Centre in India
Journal – Journal of Gastrointestinal Oncology
Publication date – Feb – 2020
Authors – Praveen Kammar, Aditi Chaturvedi, Masillamany Sivasanker, Ashwin de’Souza, Reena Engineer, Vikas Ostwal, Avanish Saklani
Keywords – Delayed surgery, Radiation, rectal cancer
Open access – Yes
Speciality – Surgical oncology
World region Southern Asia
Language – English
Submitted to the One Surgery Index on May 22, 2020 at 8:22 am
Delaying surgery after chemoradiation is one of the strategies for increasing tumor regression in rectal cancer. Tumour regression and PCR are known to have positive impact on survival.
It’s a retrospective study of 161 patients undergoing surgery after neoadjuvant chemoradiation (NCRT) for locally advanced rectal cancer (LARC). Patients were divided into three categories based on the gap between NCRT and surgery, i.e., 12 weeks. Tumor regression grades (TRG), sphincter preservation, post-operative morbidity-mortality and survival were evaluated.
Sphincter preservation was significantly less in >12 weeks group compared to the other two groups (P=0.003). Intraoperative blood loss was significantly higher in >12 weeks group compared to 8-12 weeks group (P=0.001).There was no difference in major postoperative morbidity and hospital stay among the groups. There was no significant correlation between delay and TRG (P=0.644). At Median follow up of 49.5 months the projected 3-year overall survival (OS) and disease free survival (DFS) were not significantly different among the 3 groups (OS: 79.5% vs. 83.3% vs. 76.5%; P=0.849 and DFS 50.4% vs. 70.6% vs. 62%; P=0.270 respectively).
Delaying surgery by more than 12 weeks causes more blood loss but no change in morbidity or hospital stay. Increased time interval between radiation and surgery does not improve tumor regression and has no effect on survival.
OSI Number – 20398
PMID – 32175101