Effect of neoadjuvant therapy on early postoperative complications in rectal cancer
Authors:
F. Pazdírek 1; M. Vjaclovský 1; M. Grega 2; J. Hoch 1
Published in the journal:
Rozhl. Chir., 2023, roč. 102, č. 10, s. 402-406.
Category:
Original articles
doi:
https://doi.org/10.33699/PIS.2023.102.10.402–406
Summary
Introduction: The treatment of locally advanced rectal cancer is multimodal. It includes neoadjuvant chemoradiotherapy (NCHRT). NCHRT has been shown to reduce the risk of local recurrence. New treatment regimens also have a positive impact on patient survival. NCHRT leads to fibrotic changes in the pelvis and is associated with side effects. NCHRT may have a negative impact on postoperative complications. The aim of this study was to demonstrate whether NCHRT increases the number of early postoperative complications.
Methods: An analysis of our own cohort of 200 patients with rectal cancer undergoing robotic-assisted surgery between 2018 and 2022 was performed. The cohort was divided into patients who underwent NCHRT and subsequently surgery and patients who underwent primary surgery. The two groups were compared in terms of duration of surgery, blood loss, incidence of anastomotic complications, and quality of mesorectal excision. Results: Patients who underwent NCHRT had a longer operation time, by 34 minutes on average. We did not demonstrate a higher incidence of anastomotic complications in these patients. Patients who underwent primary surgery had a slightly lower blood loss and better quality of mesorectal excision during surgery. Nevertheless, complete or nearly complete mesorectal anastomosis was achieved in more than 85% of cases in both groups.
Conclusion: Radiotherapy results in postradiation changes in the lesser pelvis. These changes impair visibility and dissection during surgery. Operations after NCHRT are more technically demanding and take longer but do not have more anastomotic complications. Also, the quality of mesorectal excision is satisfactory in both groups.
Keywords:
surgery – rectal cancer – Chemoradiotherapy – neoadjuvant treatment – complications
Zdroje
1. Quirke P, Dixon MF, Durdey P, et al. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: Histopathological study of lateral tumour spread and surgical excision. Lancet 1986;328(8514):996−999. doi:10.1016/ S0140-6736(86)92612-7.
2. Wang CL, Qu G, Xu HW. The shortand long-term outcomes of laparoscopic versus open surgery for colorectal cancer: a meta-analysis. Int J Colorectal Dis. 2014;29(3):309−320. doi:10.1007/ s00384-013-1827-1.
3. Fokas E, Allgäuer M, Polat B, et al. Randomized phase II trial of chemoradiotherapy plus induction or consolidation chemotherapy as total neoadjuvant therapy for locally advanced rectal cancer: CAO/ARO/AIO-12. J Clin Oncol. 2019; 37(34):3212−3222. doi:10.1200/jco.19. 00308.
4. Bahadoer RR, Dijkstra EA, van Etten B, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncology 2021;22(1):29−42. doi:10.1016/ S1470-2045(20)30555-6.
5. Conroy T, Bosset JF, Etienne PL, et al. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncology 2021;22(5):702−715. doi:10.1016/S14702045(21)00079-6
6. Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncology 2010;11(9): 835−844. doi:10.1016/s1470-2045(10) 70172-8.
7. Pazdirek F, Minarik M, Benesova L, et al. Current possibilities of predicting the therapeutic response to neoadjuvant chemoradiotherapy in rectal cancer. Gastroent Hepatol. 2020;74(5):393–403. doi:10.14735/amgh2020393.
8. Carr ND, Pullen BR, Hasleton PS, et al. Microvascular studies in human radiation bowel disease. Gut 1984;25(5):448−454.doi:10.1136/gut.25.5.448.
9. Hasleton PS, Carr N, Schofield PF. Vascular changes in radiation bowel disease. Histopathology 1985;9(5):517−534. doi: 10.1111/j.1365-2559.1985.tb02833.x.
10. Pollack J, Holm T, Cedermark B, et al. Long-term effect of preoperative radiation therapy on anorectal function. Diseases of the Colon and Rectum 2006;49(3):345−352. doi:10.1007/s10350-005-0296-1.
11. Peeters KC, van de Velde CJ, Leer JW, et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients − a Dutch colorectal cancer group study. J Clin Oncol. 2005;23(25): 6199−6206. doi:10.1200/jco.2005.14. 779.
12. Dahlberg M, Glimelius B, Graf W, Pahlman L. Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study. Diseases of the Colon and Rectum 1998;41(5):543−549; discussion 9−51.
13. Ekkarat P, Boonpipattanapong T, Tantiphlachiva K, et al. Factors determining low anterior resection syndrome after rectal cancer resection: A study in Thai patients. Asian Journal of Surgery 2016;39(4):225−231. doi:10.1016/j.asjsur. 2015.07.003.
14. Ramphal W, Boeding JRE, Gobardhan PD, et al. Oncologic outcome and recurrence rate following anastomotic leakage after curative resection for colorectal cancer. Surgical Oncology 2018;27(4):730−736. doi:10.1016/j.suronc.2018.10.003.
15. Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology 2018;29(Suppl 4):iv263. doi:10.1093/annonc/mdy161.
16. Kiss I. Modrá kniha České onkologické společnosti. Masarykův onkologický ústav, Brno 2021.
17. Miskovic D, Ahmed J, Bissett-Amess R, et al. European consensus on the standardization of robotic total mesorectal excision for rectal cancer. Colorectal Dis. 2019;21(3):270−276. doi:10.1111/ codi.14502.
18. Hoch J, Ferko A, Bláha M, et al. Parametric monitoring of the quality of total mesorectal excision and surgical treatment of rectal carcinoma results of a multicenter study. [Article in Czech] Rozhledy v chirurgii 2016;95(7):262−271.
19. Loughrey MB, Webster F, Arends MJ, et al. Dataset for pathology reporting of colorectal cancer: Recommendations from the International collaboration on cancer reporting (ICCR). Annals of Surgery 2022;275(3):e549−e61. doi:10.1097/ sla.0000000000005051.
20. Verweij ME, Franzen J, van Grevenstein WMU, et al. Timing of rectal cancer surgery after short-course radiotherapy: national database study. British Journal of Surgery 2023;110(7):839−845. doi:10.1093/bjs/znad113.
21. Lefevre JH, Mineur L, Kotti S, et al. Effect of Interval (7 or 11 weeks) between neoadjuvant radiochemotherapy and surgery on complete pathologic response in rectal cancer: A multicenter, randomized, controlled trial (GRECCAR-6). J Clin Oncol. 2016;34(31):3773−3780. doi:10.1200/jco. 2016.67.6049.
22. Bauer PS, Chapman WC, Atallah C, et al. Perioperative complications after proctectomy for rectal cancer: Does neoadjuvant regimen matter? Annals of Surgery 2022;275(2):e428−e32. doi:10.1097/ SLA. 0000000000003885.
23. Xu Z, Valente MA, Sklow B, et al. Impact of total neoadjuvant therapy on postoperative outcomes after proctectomy for rectal cancer. Diseases of the Colon and Rectum 2023;66(7):1022−1028. doi: 10.1097/DCR.0000000000002555.
24. Qin Q, Ma T, Deng Y, et al. Impact of preoperative radiotherapy on anastomotic leakage and stenosis after rectal cancer resection: Post hoc analysis of a randomized controlled trial. Diseases of the Colon and Rectum 2016;59(10):934−942. doi:10.1097/DCR.0000000000000665.
25. Yang J, Luo Y, Tian T, et al. Effects of neoadjuvant radiotherapy on postoperative complications in rectal cancer: A meta-analysis. J Oncol. 2022;2022:8197701. doi:10.1155/2022/8197701.
26. Hu MH, Huang RK, Zhao RS, et al. Does neoadjuvant therapy increase the incidence of anastomotic leakage after anterior resection for mid and low rectal cancer? A systematic review and meta-analysis. Colorectal Dis. 2017;19(1):16−26. doi:10.1111/codi.13424.
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Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
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