Li WC, Zhao JK, Feng WQ, Miao YM, Xu ZF, Xu ZQ, Gao H, Sun J, Zheng MH, Zong YP, Lu AG. Retrospective research of neoadjuvant therapy on tumor-downstaging, post-operative complications, and prognosis in locally advanced rectal cancer. World J Gastrointest Surg 2021; 13(3): 267-278 [PMID: 33796215 DOI: 10.4240/wjgs.v13.i3.267]
Corresponding Author of This Article
Ai-Guo Lu, MD, PhD, Chief Doctor, Professor, Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Road, Shanghai 200025, China. luaiguo1965@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Wen-Chang Li, Jing-Kun Zhao, Wen-Qing Feng, Yi-Ming Miao, Zi-Feng Xu, Zhuo-Qing Xu, Han Gao, Jing Sun, Min-Hua Zheng, Ya-Ping Zong, Ai-Guo Lu, Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
Author contributions: Li WC and Zhao JK contributed equally to this study; Li WC, Zhao JK, Zong YP, and Lu AG designed the research; Feng WQ, Miao YM, and Xu ZF collected the data and prepared the manuscript; Li WC, Zhao JK, Xu ZQ, and Gao H analyzed the data and wrote the manuscript; Sun J and Zheng MH helped design the study with constructive discussions; All authors have read and approved the final manuscript.
Supported byNational Science Foundation of China, No. 81871933; and National Science Foundation of China for Youth, No. 81802326.
Institutional review board statement: The study was reviewed and approved by the Shanghai Ruijin Hospital Ethics Committee (Approval No. 2016-072).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ai-Guo Lu, MD, PhD, Chief Doctor, Professor, Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, No. 197 Ruijin 2nd Road, Shanghai 200025, China. luaiguo1965@163.com
Received: October 9, 2020 Peer-review started: October 9, 2020 First decision: December 8, 2020 Revised: December 13, 2020 Accepted: January 15, 2021 Article in press: January 15, 2021 Published online: March 27, 2021 Processing time: 157 Days and 19.9 Hours
Abstract
BACKGROUND
Neoadjuvant therapy (NAT) is becoming increasingly important in locally advanced rectal cancer. Hence, such research has become a problem.
AIM
To evaluate the downstaging effect of NAT, its impact on postoperative complications and its prognosis with different medical regimens.
METHODS
Seventy-seven cases from Shanghai Ruijin Hospital affiliated with Shanghai Jiaotong University School of Medicine were retrospectively collected and divided into the neoadjuvant radiochemotherapy (NRCT) group and the neoadjuvant chemotherapy (NCT) group. The differences between the two groups in tumor regression, postoperative complications, rectal function, disease-free survival, and overall survival were compared using the χ2 test and Kaplan-Meier analysis.
RESULTS
Baseline data showed no statistical differences between the two groups, whereas the NRCT group had a higher rate of T4 (30/55 vs 5/22, P < 0.05) than the NCT groups. Twelve cases were evaluated as complete responders, and 15 cases were evaluated as tumor regression grade 0. Except for the reduction rate of T stage (NRCT 37/55 vs NCT 9/22, P < 0.05), there was no difference in effectiveness between the two groups. Preoperative radiation was not a risk factor for poor reaction or anastomotic leakage. No significant difference in postoperative complications and disease-free survival between the two groups was observed, although the NRCT group might have better long-term overall survival.
CONCLUSION
NAT can cause tumor downstaging preoperatively or even complete remission of the primary tumor. Radiochemotherapy could lead to better T downstaging and promising overall survival without more complications.
Core Tip: Neoadjuvant therapy can cause tumor downstaging preoperatively or even complete remission of the primary tumor. Radiochemotherapy had better T downstaging as well as promising overall survival without major complications. This may help clinicians realize the indispensability of preoperative radiation.
