Tsai TJ, Syu KJ, Huang XY, Liu YS, Chen CW, Wu YH, Lin CM, Chang YY. Identifying timing and risk factors for early recurrence of resectable rectal cancer: A single center retrospective study. World J Gastrointest Surg 2024; 16(9): 2842-2852 [DOI: 10.4240/wjgs.v16.i9.2842]
Corresponding Author of This Article
Yu-Yao Chang, Doctor, Division of Colon and Rectal Surgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao Street, Changhua 50006, Taiwan. 177176@cch.org.tw
Research Domain of This Article
Surgery
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/
Tsung-Jung Tsai, Kai-Jyun Syu, Xuan-Yuan Huang, Yu Shih Liu, Chang-Wei Chen, Yen-Hang Wu, Yu-Yao Chang, Division of Colon and Rectal Surgery, Department of Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
Ching-Min Lin, Department of Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
Yu-Yao Chang, Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
Author contributions: Tsai TJ wrote the manuscript; Syu KJ, Huang XY and Liu YS collected the data; Chang YY guided the study; Chen CW, Wu YH and Lin CM provided the study design and data analysis. All authors reviewed, edited, and approved the final manuscript and revised it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Changhua Christian Hospital.
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 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Yao Chang, Doctor, Division of Colon and Rectal Surgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao Street, Changhua 50006, Taiwan. 177176@cch.org.tw
Received: March 20, 2024 Revised: July 18, 2024 Accepted: July 26, 2024 Published online: September 27, 2024 Processing time: 181 Days and 19.4 Hours
Abstract
BACKGROUND
Colorectal cancer is a common malignancy and various methods have been introduced to decrease the possibility of recurrence. Early recurrence (ER) is related to worse prognosis. To date, few observational studies have reported on the analysis of rectal cancer. Hence, we reported on the timing and risk factors for the ER of resectable rectal cancer at our institute.
AIM
To analyze a cohort of patients with local and/or distant recurrence following the radical resection of the primary tumor.
METHODS
Data were retrospectively collected from the institutional database from March 2011 to January 2021. Clinicopathological data at diagnosis, perioperative and postoperative data, and first recurrence were collected and analyzed. ER was defined via receiver operating characteristic curve. Prognostic factors were evaluated using the Kaplan–Meier method and Cox proportional hazards modeling.
RESULTS
We included 131 patients. The optimal cut off value of recurrence-free survival (RFS) to differentiate between ER (n = 55, 41.9%) and late recurrence (LR) (n = 76, 58.1%) was 8 mo. The median post-recurrence survival (PRS) of ER and LR was 1.4 mo and 2.9 mo, respectively (P = 0.008) but PRS was not strongly associated with RFS (R² = 0.04). Risk factors included age ≥ 70 years [hazard ratio (HR) = 1.752, P = 0.047], preoperative concurrent chemoradiotherapy (HR = 3.683, P < 0.001), colostomy creation (HR = 2.221, P = 0.036), and length of stay > 9 d (HR = 0.441, P = 0.006).
CONCLUSION
RFS of 8 mo was the optimal cut-off value. Although ER was not associated with PRS, it was still related to prognosis; thus, intense surveillance is recommended.
Core tip: Definitions of early recurrence (ER) in resectable rectal cancer are scare, and the guidelines for surveillance of postoperative condition differ. This study provides information on the ER cutoff time and emphasizes the importance of the intense surveillance of postoperative patients, especially during the first year after surgery. Our study also provides the risk factors for early recurrence.
