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Post-Operative Morbidity and Mortality Following Total Neoadjuvant Therapy Versus Conventional Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer

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Abstract

Background

Standard of care for locally advanced rectal cancer (LARC) (stage II/III) includes preoperative chemoradiation (CRT) followed by resection and adjuvant chemotherapy. Total neoadjuvant therapy (TNT) is a new treatment paradigm that delivers systemic therapy prior to CRT aimed at improving outcomes for high-risk patients. Here we analyzed the national cancer database (NCDB) comparing short-term post-operative outcomes between patients receiving TNT and CRT.

Methods

The NCDB was queried to identify patients with LARC between the 2004 and 2014 treated with TNT or CRT. Primary outcomes included post-operative 30-day mortality and readmissions between TNT and CRT which were analyzed via logistic regression. Secondary outcomes included post-operative length of stay (LOS) and OS which were compared with two-tailed t-test and Kaplan-Meier with log rank testing, respectively.

Results

A total of 9066 patients met inclusion criteria with a median age at diagnosis that was 57 years (IQR, 19–65); 62.3% were male and 87.8% white. Neoadjuvant therapy consisted of either standard CRT (97.2%) or TNT (2.8%). Patients treated at academic programs and those with N1 [p < 0.001, OR 2.34, 95%CI 1.71–3.19] or N2 [p < 0.001, OR 3.29, 95%CI 2.19–4.94] disease were associated with increased utilization of TNT. TNT was not significantly associated with either 30-day mortality (p = 1.0) or readmissions (p = 0.82). Further, there was no significant difference identified between CRT and TNT for hospital LOS or OS (p = 0.18).

Conclusion

This large-scale analysis of patients with LARC demonstrates increased utilization of TNT in patients harboring node-positive disease. Further, TNT does not appear to increase 30-day post-operative mortality, readmissions, or hospital LOS.

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Authors and Affiliations

  1. Department of Internal Medicine, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA, 15212, USA

    Philip Sutera

  2. Division of Colorectal Surgery, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA, 15212, USA

    Julia Solomina & James McCormick

  3. Division of Radiation Oncology, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA, 15212, USA

    Rodney E. Wegner, Stephen Abel & Alexander V. Kirichenko

  4. Division of Medical Oncology, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA, 15212, USA

    Dulabh Monga & Gene Finley

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  1. Philip Sutera
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Corresponding author

Correspondence to Rodney E. Wegner.

Ethics declarations

As the NCDB contains de-identified data, the study was exempt from institutional review board supervision.

Conflict of Interest

James McCormick: Proctor and speaker for intuitive surgical.

Gene Finely: Financial relationships with BMS, MERCK, AZ

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Sutera, P., Solomina, J., Wegner, R.E. et al. Post-Operative Morbidity and Mortality Following Total Neoadjuvant Therapy Versus Conventional Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer. J Gastrointest Canc 52, 976–982 (2021). https://doi.org/10.1007/s12029-020-00401-3

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  • DOI: https://doi.org/10.1007/s12029-020-00401-3

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