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Long-Term Results After Neoadjuvant Radiochemotherapy for Locally Advanced Resectable Extraperitoneal Rectal Cancer

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Diseases of the Colon & Rectum

Purpose

This study was designed to evaluate long-term outcome in locally advanced resectable extraperitoneal rectal cancer treated by preoperative radiochemotherapy.

Methods

Eighty-three consecutive patients who developed locally advanced resectable extraperitoneal rectal cancer underwent preoperative concomitant radiochemotherapy followed by surgery, including total mesorectal excision.

Results

Median follow-up was 108 (range, 10–169) months. The living patients underwent complete follow-up of, at least, nine years. Fourteen patients developed local recurrence. The time to detection was longer than two years in eight cases and longer than five years in four. Twenty-one patients developed metastases, 19 within the first five years from surgery. At the univariate analysis, clinical stage at presentation, lymph node involvement at clinical restaging after neoadjuvant therapy, and pTand pN stage were found positively correlated to the incidence of metastases. At the multivariate analysis, the only factors which confirmed a positive correlation were pT stage and pN stage. The actuarial overall survival at five, seven, and ten years was 75.5, 67.8, and 60.4 percent, respectively. The same figures for cancer-related survival were 77.9, 70, and 65.8 percent. At the univariate analysis, factors directly correlated with worse survival were: TNM stage at clinical restaging after neoadjuvant therapy (in particular lymph node involvement) pTNM, pT, and pN. At the multivariate analysis the only factors that confirmed a correlation with worse survival were pTNM, pT, and pN.

Conclusions

Long- term follow-up allows to individuate 28 percent of all local relapses after the first five years from surgery. Postoperative stage is highly predictive of prognosis.

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Author information

Authors and Affiliations

  1. Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy

    Claudio Coco M.D., Alberto Manno M.D., Claudio Mattana M.D., F.A.S.C.R.S., Alessandro Verbo M.D., Giorgio Pedretti M.D., Luigi Petito M.D., Gianluca Rizzo M.D. & Aurelio Picciocchi M.D.

  2. Department of Radiation Therapy, Università Cattolica del Sacro Cuore, Rome, Italy

    Vincenzo Valentini M.D., Numa Cellini M.D., Maria Antonietta Gambacorta M.D., Giovanna Mantini M.D. & Francesco Miccichè M.D.

  3. Department of Emergency Medicine, Università Cattolica del Sacro Cuore, Rome, Italy

    Marcello Covino M.D.

  4. Department of Surgery, Istituto Nazionale dei Tumori Regina Elena, Rome, Italy

    Maurizio Cosimelli M.D.

  5. Department of Radiation Therapy, Istituto Nazionale dei Tumori Regina Elena, Rome, Italy

    Fabrizio Ambesi Impiombato M.D.

Authors
  1. Claudio Coco M.D.
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  2. Vincenzo Valentini M.D.
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  4. Claudio Mattana M.D., F.A.S.C.R.S.
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  6. Numa Cellini M.D.
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  9. Giovanna Mantini M.D.
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  10. Francesco Miccichè M.D.
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  11. Giorgio Pedretti M.D.
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  12. Luigi Petito M.D.
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  13. Gianluca Rizzo M.D.
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  14. Maurizio Cosimelli M.D.
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  15. Fabrizio Ambesi Impiombato M.D.
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  16. Aurelio Picciocchi M.D.
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Corresponding author

Correspondence to Alberto Manno M.D..

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Coco, C., Valentini, V., Manno, A. et al. Long-Term Results After Neoadjuvant Radiochemotherapy for Locally Advanced Resectable Extraperitoneal Rectal Cancer. Dis Colon Rectum 49, 311–318 (2006). https://doi.org/10.1007/s10350-005-0291-6

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  • DOI: https://doi.org/10.1007/s10350-005-0291-6

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