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The Role of Adjuvant Chemotherapy in ypT0N0 Rectal Adenocarcinoma

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

In patients who develop a complete pathologic response (ypT0N0) following neoadjuvant chemoradiation, the benefits of postoperative chemotherapy remain uncertain. This study aims to determine whether treatment with adjuvant chemotherapy in ypT0N0 patients affects short- and long-term outcomes.

Methods

From January 2000 to December 2015, 992 patients at our institution underwent surgery for rectal adenocarcinoma following treatment with neoadjuvant chemoradiation. A complete pathologic response was noted in 96 (9.7%) patients. Adjuvant chemotherapy was administered to 60 (62.5%) patients. We reviewed clinical and pathological records and compared outcomes in ypT0N0 patients who received adjuvant chemotherapy to those who did not.

Results

The mean age of patients who received adjuvant chemotherapy was 55.6 ± 11.5 years, compared to 62.1 ± 11.7 years for those who did not (p = 0.008). Among the two groups, mean follow-up time after surgery was 5.3 ± 4.1 years for the adjuvant group and 8.3 ± 5.5 years for the non-adjuvant cohort (p = 0.003). The 1, 3, and 5-year survival rates were 100.0%, 97.7%, and 92.1% for patients who received adjuvant chemotherapy and 97.2%, 94.1%, and 90.7% for those who did not (p = 0.382). In a subanalysis of patients with available follow-up information, we observed 3/53 (5.7%) disease recurrences in patients who received adjuvant chemotherapy, compared to 2/18 (11.1%) in those who were not treated postoperatively (p = 0.456).

Conclusion

In patients with ypT0N0 rectal adenocarcinoma, we found equivalent survival and recurrence outcomes. Further study will be necessary to determine the importance of adjuvant chemotherapy following ypT0N0 resection.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA

    Anita Nguyen

  2. Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Anita Nguyen, David R. James, Eric J. Dozois, Scott R. Kelley & Kellie L. Mathis

Authors
  1. Anita Nguyen
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  2. David R. James
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  3. Eric J. Dozois
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  4. Scott R. Kelley
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  5. Kellie L. Mathis
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Correspondence to Kellie L. Mathis.

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Synopsis

In this study of 96 patients with ypT0N0 rectal adenocarcinoma, we found equivalent survival and recurrence outcomes. Further study will be necessary to determine the importance of adjuvant chemotherapy following ypT0N0 resection.

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Nguyen, A., James, D.R., Dozois, E.J. et al. The Role of Adjuvant Chemotherapy in ypT0N0 Rectal Adenocarcinoma. J Gastrointest Surg 23, 2263–2268 (2019). https://doi.org/10.1007/s11605-019-04129-9

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  • DOI: https://doi.org/10.1007/s11605-019-04129-9

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