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Role of the Interval from Completion of Neoadjuvant Therapy to Surgery in Postoperative Morbidity in Patients with Locally Advanced Rectal Cancer

  • Campbell S. D. Roxburgh
  • Paul Strombom
  • Patricio Lynn
  • Mithat Gonen
  • Philip B. Paty
  • Jose G. Guillem
  • Garrett M. Nash
  • J. Joshua Smith
  • Iris Wei
  • Emmanouil Pappou
  • Julio Garcia-Aguilar
  • Martin R. WeiserEmail author
Colorectal Cancer
  • 76 Downloads

Abstract

Background

Increasing the interval from completion of neoadjuvant therapy to surgery beyond 8 weeks is associated with increased response of rectal cancer to neoadjuvant therapy. However, reports are conflicting on whether extending the time to surgery is associated with increased perioperative morbidity.

Methods

Patients who presented with a tumor within 15 cm of the anal verge in 2009–2015 were grouped according to the interval between completion of neoadjuvant therapy and surgery: < 8 weeks, 8–12 weeks, and 12–16 weeks.

Results

Among 607 patients, the surgery was performed at < 8 weeks in 317 patients, 8–12 weeks in 229 patients, and 12–16 weeks in 61 patients. Patients who underwent surgery at 8–12 weeks and patients who underwent surgery at < 8 weeks had comparable rates of complications (37% and 44%, respectively). Univariable analysis identified male sex, earlier date of diagnosis, tumor location within 5 cm of the anal verge, open operative approach, abdominoperineal resection, and use of neoadjuvant chemoradiotherapy alone to be associated with higher rates of complications. In multivariable analysis, male sex, tumor location within 5 cm of the anal verge, open operative approach, and neoadjuvant chemoradiotherapy administered alone were independently associated with the presence of a complication. The interval between neoadjuvant therapy and surgery was not an independent predictor of postoperative complications.

Conclusions

Delaying surgery beyond 8 weeks from completion of neoadjuvant therapy does not appear to increase surgical morbidity in rectal cancer patients.

Notes

Acknowledgment

This research was supported in part by the NCI Grant P30 CA008748. The authors gratefully acknowledge Arthur Gelmis for editing the manuscript.

Funding

NCI P30 CA008748.

Supplementary material

10434_2019_7340_MOESM1_ESM.docx (47 kb)
Supplementary material 1 (DOCX 46 kb)

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Campbell S. D. Roxburgh
    • 1
    • 2
  • Paul Strombom
    • 1
  • Patricio Lynn
    • 1
  • Mithat Gonen
    • 3
  • Philip B. Paty
    • 1
  • Jose G. Guillem
    • 1
  • Garrett M. Nash
    • 1
  • J. Joshua Smith
    • 1
  • Iris Wei
    • 1
  • Emmanouil Pappou
    • 1
  • Julio Garcia-Aguilar
    • 1
  • Martin R. Weiser
    • 1
    Email author
  1. 1.Colorectal Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
  3. 3.Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA

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