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Outcomes of exenteration in cT4 and fixed cT3 stage primary rectal adenocarcinoma: a subgroup analysis of consolidation chemotherapy following neoadjuvant concurrent chemoradiotherapy

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Abstract

Purpose

The aim was to evaluate the oncological outcomes and the prognostic factors following pelvic exenteration (PE) in cT4 and fixed cT3 stage primary rectal adenocarcinoma and to study the impact of consolidation chemotherapy following neoadjuvant concurrent chemoradiotherapy (NACRT).

Methods

A retrospective analysis of a prospectively maintained database of PE from 2013 to 2018.

Results

Out of 2900 colorectal resections, there were 131 pelvic exenterations that were performed, and 100 of these patients had undergone exenteration for primary rectal adenocarcinoma. Of these 100 patients, there were 81 patients who had received NACRT followed by surgery, 50 of whom who had received consolidation chemotherapy and 31 who had undergone surgery without consolidation chemotherapy. R0 resection was achieved in 90% cases. At a median follow-up of 32 months, 2-year disease free survival was 61.8% and estimated 5-year overall survival was 62%. The incidence of distant metastases was 44% vs. 19% (p = 0.023), and the 2-year distant recurrence-free survival was 58% vs. 89% (p = 0.025), respectively, in the ‘consolidation chemotherapy group’ and the ‘no chemotherapy group’. The poorly differentiated grade of tumours, presence of lympho-vascular-invasion, consolidation chemotherapy, and disease recurrence were all found to affect the survival.

Conclusion

PE with R0 resection achieves excellent survival rates in cT4 and fixed cT3 stage primary rectal adenocarcinoma. The distant recurrence rate may not be altered by consolidation chemotherapy in the subset of high-risk patients. However, further research on consolidation chemotherapy following NACRT in cT4 and fixed cT3 stage primary rectal adenocarcinoma will give a definite answer in the future.

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Data will be provided on request.

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Authors and Affiliations

  1. Department of Surgical Oncology, Manipal Comprehensive Cancer Care Center, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India

    Naveena AN Kumar

  2. Department of Colorectal Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra, 400012, India

    Ashwin Desouza, Sajith P. Sasi, Kamlesh Verma & Avanish Saklani

  3. Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, 400012, India

    Vikas Ostwal & Anant Ramaswamy

  4. Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, 400012, India

    Reena Engineer

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  1. Naveena AN Kumar
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  2. Ashwin Desouza
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  3. Vikas Ostwal
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  4. Sajith P. Sasi
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  5. Kamlesh Verma
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  6. Anant Ramaswamy
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  8. Avanish Saklani
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Contributions

NK, AD, and AS did the study conception and design. NK, SS, and KV acquired the data. NK, AD, VO, AR, RE, and AS performed the analysis and interpretation of data. NK, AD, VO, SS, KV, AR, RE, and AS drafted the manuscript. NK, AD, VO, RE, and AS are responsible for the critical revision of manuscript.

Corresponding author

Correspondence to Avanish Saklani.

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Kumar, N.A., Desouza, A., Ostwal, V. et al. Outcomes of exenteration in cT4 and fixed cT3 stage primary rectal adenocarcinoma: a subgroup analysis of consolidation chemotherapy following neoadjuvant concurrent chemoradiotherapy. Langenbecks Arch Surg 406, 821–831 (2021). https://doi.org/10.1007/s00423-021-02143-7

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