Author:
Deen Raeed,Ediriweera Dileepa S,Thillakaratne Suchintha,Hewavissenthi Janaki,Kumarage Sumudu K,Chandrasinghe Pramodh C.
Abstract
Abstract
Background
Pre-operative long-course chemoradiotherapy (CRT) for rectal cancer has resulted in improvement in rates of restorative rectal resection and local recurrence by inducing tumour downstaging and downsizing. Total mesorectal excision (TME) is a standardised surgical technique of low anterior resection aimed at the prevention of local tumour recurrence. The purpose of this study was to evaluate tumour response following CRT in a standardised group of patients with rectal cancer.
Methods
One hundred and thirty-one patients (79 male; 52 female, median age 57; interquartile range 47–62 years) of 153 with rectal cancer who underwent pre-operative long-course CRT were treated by standardised open low anterior resection at a median of 10 weeks post-CRT. Sixteen of 131 (12%) were 70 years or older. Median follow-up at the time of analysis was 15 months (interquartile range 6–45 months). Pathology reports were analysed based on AJCC-UICC classification using the TNM system. Data recorded were overall/subgrades of tumour regression; good, moderate or poor, lymph node harvest, local recurrence, disease-free and overall survival using standard statistical methods.
Results
78% showed tumour regression post-CRT; 43% displayed good tumour regression/response while 22% had poor tumour regression/response. All patients had a pre-operative T-stage of either T3 or T4. Post-operation, good responders had a median T stage of T2 vs. T3 in poor responders (P = 0.0002). Overall, the median lymph node harvest was < 12. There was no difference in the number of nodes harvested in good vs. poor responders (Good/moderate-6 nodes vs. Poor- 8; P = 0.31). Good responders tended to have a lesser number of malignant nodes vs. poor responders (P = 0.31). Overall, local recurrence was 6.8% and the anal sphincter preservation rate was 89%. Predicted 5-year disease-free and overall survival were similar between good and poor responders.
Conclusion
Long-course CRT resulted in satisfactory tumour regression and enabled consideration for safe, sphincter-saving resection in rectal cancer. A dedicated multi-disciplinary team approach achieved a global benchmark for local recurrence in a resource-limited setting.
Funder
National Research Council Sri Lanka
Publisher
Springer Science and Business Media LLC
Subject
Cancer Research,Genetics,Oncology
Reference37 articles.
1. Corman M. Classic articles in colonic and rectal surgery. A method of performing abdominoperineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon: by W. Ernest Miles, 1869–1947. Diseases of the colon and rectum. 1980;23(3):202-5.
2. Heimann TH, Szporn A, Bolnick K, Aufses AH. Local recurrence following surgical treatment of rectal cancer: comparison of anterior and abdominoperineal resection. Dis colon rectum. 1986;29:862–4.
3. Karanjia N, Schache D, North W, Heald R. Close shave’in anterior resection. Br J Surg. 1990;77(5):510–2.
4. Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol. 2008;26(2):303–12.
5. Beets-Tan RG, Lambregts DM, Maas M, Bipat S, Barbaro B, Curvo-Semedo L, et al. Magnetic resonance imaging for clinical management of rectal cancer: updated recommendations from the 2016 european Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting. Eur Radiol. 2018;28:1465–75.