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Long-term Oncologic Outcomes After Neoadjuvant Chemoradiation Followed by Intersphincteric Resection With Coloanal Anastomosis for Locally Advanced Low Rectal Cancer

Park, Jun Seok, M.D.1; Park, Soo Yeun, M.D.1; Kim, Hye Jin, M.D.1; Cho, Seung Hyun, M.D.1,2; Kwak, Sang Gyu, Ph.D.3; Choi, Gyu-Seog, M.D.1

Diseases of the Colon & Rectum: April 2019 - Volume 62 - Issue 4 - p 408–416
doi: 10.1097/DCR.0000000000001321
Original Contributions: Colorectal Cancer
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BACKGROUND: To date only few data have been available relating to the oncologic safety of intersphincteric resection in such advanced tumors.

OBJECTIVE: This study aimed to elucidate the oncologic outcomes and clinical factors affecting the long-term survival of patients who underwent preoperative chemoradiotherapy followed by intersphincteric resection for locally advanced rectal cancers.

DESIGN: This was a retrospective analysis of prospectively collected departmental data.

SETTINGS: The study was conducted at a department of colorectal surgery in a tertiary care teaching hospital between January 2009 and September 2015.

PATIENTS: A cohort of 147 consecutive patients with low rectal cancer undergoing intersphincteric resection after preoperative chemoradiotherapy was included.

MAIN OUTCOME MEASURES: Kaplan–Meier analyses were used to evaluate the 3-year disease-free survival and local recurrence rates. Logistic regression analyses were used to analyze the influence of tumor response and other prognostic factors on survival outcomes.

RESULTS: Median follow-up was 34 months (range, 8–94 mo). The estimated overall 3-year disease-free survival and local recurrence rates were 64.9% and 11.7%. Circumferential resection margin involvement and pathologic T stage (ypT stage) were significant predictors of cancer relapse. The 3-year disease-free survival was 47.4% for patients with ypT3 tumors compared with 82.0% for those with ypT0–2 tumors (p = 0.001). The 3-year disease-free survival was 36.5% for patients with involved circumferential resection margins compared with 69.7% for those with a noninvolved circumferential resection margin (p = 0.003). On multivariate analysis, ypT stage, ymrT stage, and circumferential resection margin status were associated with worse disease-free survival. Clinical T-stage and pathologic distal margin status were not independent factors affecting oncologic outcomes.

LIMITATIONS: This study is limited with respect to its retrospective design.

CONCLUSIONS: In these patients with locally advanced low rectal cancers, intersphincteric resection after preoperative chemoradiotherapy was associated with acceptable oncologic outcomes. See Video Abstract at http://links.lww.com/DCR/A941.

1 Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea

2 Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea

3 Department of Medical Statistics, School of Medicine, Catholic University of Daegu, Daegu, Korea

Earn Continuing Education (CME) credit online at cme.lww.com.

Funding/Support: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (2016R1D1A1B03930709).

Financial Disclosure: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, Nashville, TN, May 19 to 23, 2018.

Correspondence: Gyu-Seog Choi, M.D., Department of Surgery, Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hogukno, Buk-gu, Daegu 702-210, Korea. E-mail: kyuschoi@mail.knu.ac.kr

© 2019 The American Society of Colon and Rectal Surgeons