Does one size fit all? Risks and benefits of neoadjuvant chemoradiation in patients with clinical stage IIA rectal cancer requiring abdominoperineal resection

• Published in: The American journal of surgery 2020-03, Vol.219 (3), p.406-410
• Main Authors: de Camargo, Mariane Gouvêa Monteiro, Xhaja, Xhileta, Aiello, Alexandra, Liska, David, Gorgun, Emre, Dietz, David W., Kalady, Matthew F., Delaney, Conor P., Steele, Scott R., Valente, Michael A.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Aged; Cancer; Cancer therapies; Chemoradiotherapy; Chemoradiotherapy, Adjuvant; Chemotherapy; Colorectal cancer; Demographics; Female; Humans; Lymphatic system; Male; Middle Aged; Morbidity; Multivariate analysis; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Postoperative Complications; Proctectomy; Radiation therapy; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - therapy; Rectum; Risk Assessment; Studies; Surgery; Survival Analysis; Tumors; Ultrasonic imaging
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2019.10.037

Neoadjuvant chemoradiotherapy (nCRT) has become the standard of care for locally advanced rectal cancer, decreasing locoregional recurrence, yet with an unclear survival advantage. We aimed to assess the benefit of nCRT on oncologic and perioperative outcomes of patients with clinical stage IIA rectal adenocarcinoma treated with abdominoperineal resection (APR). Patients with clinical T3N0 rectal adenocarcinoma that underwent APR between 1995 and 2014 were included. Patients who received nCRT were compared with patients who did not. Multivariate analysis was conducted to compare oncological and perioperative outcomes between the groups. 127 patients were included, of which 94 received nCRT. Median follow-up was 11.9 years. There was no difference in circumferential margins, postoperative morbidity, and complication rates between the groups. There was no difference in 5-year oncological outcomes between the groups. No difference was found in 5-year oncological outcomes between patients with clinical T3N0 rectal adenocarcinoma necessitating an APR who received nCRT and those not receiving nCRT, with similar overall complication rates. •Neoadjuvant chemoradiotherapy (nCRT) has become the standard of care for locally advanced rectal cancer, decreasing locoregional recurrence, yet an unclear survival advantage. Its role for clinical stage IIA rectal adenocarcinoma is still subject of controversy.•Using standardized surgical techniques in the approach to rectal cancer, in general, has improved oncologic outcomes, including reducing locoregional recurrence. In abdominoperineal resection, this includes avoiding “coning in”, using wider, cylindrical excision involving the levator ani muscles with excision of the external sphincter muscles.•In this study, patients with clinical T3N0 rectal adenocarcinoma necessitating an APR who received nCRT had the same 5-year oncological outcomes as those not receiving nCRT with similar complication rates.