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Does Pathological Complete Response after Neoadjuvant Therapy Influence Postoperative Morbidity in Rectal Cancer after Transanal Total Mesorectal Excision?

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Abstract

Purpose

It is still unclear if pathological complete response (pCR) after neoadjuvant chemoradiotherapy (CRT) in patients treated for rectal cancer causes worse postoperative outcomes, especially after transanal total mesorectal excision (TaTME). Worse postoperative outcomes might be an argument for an organ preserving watch and wait strategy in fragile patients and patients with comorbidities. The aim of this study is to evaluate whether patients treated for rectal cancer who had pCR to neoadjuvant therapy develop worse postoperative outcomes after TaTME than patients without complete response.

Methods

Comparative retrospective analysis (with nearest neighbor matching algorithm) of postoperative outcomes in two groups of patients, with pCR, n = 15 and without pCR (non-pCR), n = 57. All patients were operated on only by one surgical approach, TaTME, for middle and distal rectal tumors. All procedures were performed by one surgical team between 2014 and 2020 at the University Hospital Brno in Czech Republic.

Results

Overall morbidity was comparable between the groups (pCR group – 53.8% vs. non-pCR – 38.6%, p = 0.381). Anastomotic leak (AL) was observed in 33.3% of patients with pCR and in 17.5% of patients in the non-pCR group without statistical significance (p = 0.281).

Conclusion

In conclusion, pathological complete response after neoadjuvant therapy does not appear to affect postoperative morbidity in rectal cancer after TaTME. Therefore, in patients with complete response who are not adherent to W&W surveillance, surgical resection can be perform without increased postoperative complications.

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Data Availability

The data used to support the findings of this study are available from the corresponding author upon request.

Code Availability

Not applicable.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, University Hospital Brno Bohunice, Masaryk University, Brno, Czech Republic

    Martin Svoboda, Vladimír Procházka, Tomáš Grolich & Zdeněk Kala

  2. Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic

    Tomáš Pavlík & Monika Mazalová

Authors
  1. Martin Svoboda
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  2. Vladimír Procházka
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  3. Tomáš Grolich
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  4. Tomáš Pavlík
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  5. Monika Mazalová
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  6. Zdeněk Kala
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection and analysis were performed by Vladimír Procházka, Zdeněk Kala, Tomáš Grolich, Martin Svoboda, Tomáš Pavlík, and Monika Mazalová. The first draft of the manuscript was written by Martin Svoboda and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Vladimír Procházka.

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All procedures performed were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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All individual participants included in the study gave their informed consent for the inclusion in the study and for publication of the manuscript. All authors gave consent for publication.

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The authors declare no competing interests.

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Svoboda, M., Procházka, V., Grolich, T. et al. Does Pathological Complete Response after Neoadjuvant Therapy Influence Postoperative Morbidity in Rectal Cancer after Transanal Total Mesorectal Excision?. J Gastrointest Canc 54, 528–535 (2023). https://doi.org/10.1007/s12029-022-00826-y

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