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Prognostic Factors for Postoperative Morbidity and Tumour Response After Neoadjuvant Chemoradiation Followed by Resection for Rectal Cancer

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background and Purpose

In patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation followed by rectal resection, postoperative morbidity is a significant clinical problem. Pathologic complete tumour response seems to give the best prognosis in the long term. Little is known about the factors that are associated with postoperative complications and pathologic complete response. The aim of this retrospective study was to identify and describe these factors.

Methods

Ninety-nine consecutive patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiation (50 Gy and capecitabine) followed by surgery at our institute between January 2007 and May 2012 were identified. Postoperative complications were graded according to the Clavien-Dindo classification. Pathologic tumour response was categorized as complete response or no/partial response.

Results

Postoperative complications occurred in 68 patients (69 %) and grade 3–5 complications in 25 patients (25 %). The 30-day and 90-day mortality were 1 % (n = 1) and 2 % (n = 2), respectively. A young age (p = 0.021) and a preoperative or postoperative blood transfusion (p = 0.015) independently predicted complications. Intraoperative or postoperative blood transfusion (p = 0.007) and ypT0-1 stage (p = 0.037) were independent predictors for grade 3–5 complications. Complete response rate was 22 % (n = 22); 4 % (n = 4) of patients showed no response. No independent factors predicting complete response were found.

Conclusions

Neoadjuvant chemoradiation followed by rectal resection is associated with significant postoperative morbidity but minimal postoperative mortality. A complete response rate of 22 % was achieved.

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References

  1. Grossmann I, Klaase JM, Avenarius JK, de Hingh IH, Mastboom WJ, Wiggers T. The strengths and limitations of routine staging before treatment with abdominal CT in colorectal cancer. BMC Cancer 2011 Oct 7;11:433.

  2. [2]Landelijke werkgroep Gastro Intestinale Tumoren. Landelijke evidence-based richtlijn rectumcarcinoom. 2008; Available at: http://www.oncoline.nl/rectumcarcinoom.

  3. Tulchinsky H, Shmueli E, Figer A, Klausner JM, Rabau M. An interval >7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer. Ann Surg Oncol 2008 Oct;15(10):2661-2667.

  4. Stelzmueller I, Zitt M, Aigner F et al. Postoperative morbidity following chemoradiation for locally advanced low rectal cancer. J Gastrointest Surg 2009 Apr;13(4):657-667.

  5. Dutch Surgical Colorectal Audit Jaarrapportage 2011. Available at: http://www.dsca.nl/images/documenten/2012/jaarrapportage%202011.pdf.

  6. Kerr SF, Norton S, Glynne-Jones R. Delaying surgery after neoadjuvant chemoradiotherapy for rectal cancer may reduce postoperative morbidity without compromising prognosis. Br J Surg 2008 Dec;95(12):1534-1540.

  7. Swellengrebel HA, Marijnen CA, Verwaal VJ et al. Toxicity and complications of preoperative chemoradiotherapy for locally advanced rectal cancer. Br J Surg 2011 Mar;98(3):418-426.

  8. Janjan NA, Khoo VS, Abbruzzese J et al. Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys 1999 Jul 15;44(5):1027-1038.

  9. Rodel C, Martus P, Papadoupolos T et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 2005 Dec 1;23(34):8688-8696.

  10. Kalady MF, de Campos-Lobato LF, Stocchi L et al. Predictive factors of pathologic complete response after neoadjuvant chemoradiation for rectal cancer. Ann Surg 2009 Oct;250(4):582-589.

  11. Wolthuis AM, Penninckx F, Haustermans K et al. Impact of interval between neoadjuvant chemoradiotherapy and TME for locally advanced rectal cancer on pathologic response and oncologic outcome. Ann Surg Oncol 2012 Sep;19(9):2833-2841.

  12. Das P, Skibber JM, Rodriguez-Bigas MA et al. Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer. Cancer 2007 May 1;109(9):1750-1755.

  13. Moore HG, Gittleman AE, Minsky BD et al. Rate of pathologic complete response with increased interval between preoperative combined modality therapy and rectal cancer resection. Dis Colon Rectum 2004 Mar;47(3):279-286.

  14. Francois Y, Nemoz CJ, Baulieux J et al. Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trial. J Clin Oncol 1999 Aug;17(8):2396.

  15. de Campos-Lobato LF, Geisler DP, da Luz Moreira A, Stocchi L, Dietz D, Kalady MF. Neoadjuvant therapy for rectal cancer: the impact of longer interval between chemoradiation and surgery. J Gastrointest Surg 2011 Mar;15(3):444-450.

  16. Garcia-Aguilar J, Smith DD, Avila K et al. Optimal timing of surgery after chemoradiation for advanced rectal cancer: preliminary results of a multicenter, nonrandomized phase II prospective trial. Ann Surg 2011 Jul;254(1):97-102.

  17. Habr-Gama A, Perez RO, Proscurshim I et al. Interval between surgery and neoadjuvant chemoradiation therapy for distal rectal cancer: does delayed surgery have an impact on outcome? Int J Radiat Oncol Biol Phys 2008 Jul 15;71(4):1181-1188.

  18. Clavien PA, Barkun J, de Oliveira ML et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009 Aug;250(2):187-196.

  19. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004 Aug;240(2):205-213.

  20. Lim SB, Choi HS, Jeong SY et al. Optimal surgery time after preoperative chemoradiotherapy for locally advanced rectal cancers. Ann Surg 2008 Aug;248(2):243-251.

  21. Tran CL, Udani S, Holt A, Arnell T, Kumar R, Stamos MJ. Evaluation of safety of increased time interval between chemoradiation and resection for rectal cancer. Am J Surg 2006 Dec;192(6):873-877.

  22. Stein DE, Mahmoud NN, Anne PR et al. Longer time interval between completion of neoadjuvant chemoradiation and surgical resection does not improve downstaging of rectal carcinoma. Dis Colon Rectum 2003 Apr;46(4):448-453.

  23. Bullard KM, Trudel JL, Baxter NN, Rothenberger DA. Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure. Dis Colon Rectum 2005 Mar;48(3):438-443.

  24. Wiatrek RL, Thomas JS, Papaconstantinou HT. Perineal wound complications after abdominoperineal resection. Clin Colon Rectal Surg 2008 Feb;21(1):76-85.

  25. Hay JM, Fingerhut A, Paquet JC, Flamant Y. Management of the pelvic space with or without omentoplasty after abdominoperineal resection for carcinoma of the rectum: a prospective multicenter study. The French Association for Surgical Research. Eur J Surg 1997 Mar;163(3):199-206.

  26. Nisar PJ, Scott HJ. Myocutaneous flap reconstruction of the pelvis after abdominoperineal excision. Colorectal Dis 2009 Oct;11(8):806-816.

  27. Dolinsky CM, Mahmoud NN, Mick R et al. Effect of time interval between surgery and preoperative chemoradiotherapy with 5-fluorouracil or 5-fluorouracil and oxaliplatin on outcomes in rectal cancer. J Surg Oncol 2007 Sep 1;96(3):207-212.

  28. Puig-La Calle J,Jr, Quayle J, Thaler HT et al. Favorable short-term and long-term outcome after elective radical rectal cancer resection in patients 75 years of age or older. Dis Colon Rectum 2000 Dec;43(12):1704-1709.

  29. Klein HG. Immunomodulatory aspects of transfusion: a once and future risk? Anesthesiology 1999 Sep;91(3):861-865.

  30. Gruttadauria S, Saint Georges Chaumet M, Pagano D et al. Impact of blood transfusion on early outcome of liver resection for colorectal hepatic metastases. J Surg Oncol 2011 Feb;103(2):140-147.

  31. Duldulao MP, Lee W, Le M et al. Surgical complications and pathologic complete response after neoadjuvant chemoradiation in locally advanced rectal cancer. Am Surg 2011 Oct;77(10):1281-1285.

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The authors declare that they have no conflicts of interest.

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The authors declare that there was no involvement of a funding source.

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Authors and Affiliations

  1. Department of Surgery, Medisch Spectrum Twente, Haaksbergerstraat 55, 7500, KA, Enschede, The Netherlands

    Annefleur E. M. Berkel & Joost M. Klaase

  2. Department of Radiotherapy, Medisch Spectrum Twente, Enschede, The Netherlands

    Dankert P. Woutersen

  3. Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands

    Job van der Palen

  4. Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands

    Job van der Palen

Authors
  1. Annefleur E. M. Berkel
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  2. Dankert P. Woutersen
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  3. Job van der Palen
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  4. Joost M. Klaase
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Correspondence to Joost M. Klaase.

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Berkel, A.E.M., Woutersen, D.P., van der Palen, J. et al. Prognostic Factors for Postoperative Morbidity and Tumour Response After Neoadjuvant Chemoradiation Followed by Resection for Rectal Cancer. J Gastrointest Surg 18, 1648–1657 (2014). https://doi.org/10.1007/s11605-014-2559-4

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  • DOI: https://doi.org/10.1007/s11605-014-2559-4

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