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Oncologic Outcomes in Patients Who Undergo Neoadjuvant Chemoradiotherapy and Total Mesorectal Excision for Locally Advanced Rectal Cancer: A 14-Year Experience in a Single Institution
Min Jung Kim, Seung-Yong Jeong, Ji Won Park, Seung-Bum Ryoo, Sang Sik Cho, Ki Young Lee, Kyu Joo Park
Ann Coloproctol. 2019;35(2):83-93.   Published online April 30, 2019
DOI: https://doi.org/10.3393/ac.2019.04.22.1
  • 5,130 View
  • 97 Download
  • 21 Web of Science
  • 19 Citations
AbstractAbstract PDF
Purpose
This study evaluated the oncologic outcomes of locally advanced rectal cancer patients who underwent preoperative neoadjuvant chemoradiotherapy (CRT) followed by surgery and determined the prognostic significance of pathologic complete response (pCR).
Methods
Between January 2002 and December 2015, 580 patients with rectal cancer who underwent surgery after neoadjuvant CRT were identified. Survival according to tumor response to CRT and pathologic stage was analyzed using the Kaplan-Meier method, and the Cox proportional hazard model was used to identify factors associated with survival outcomes.
Results
A total of 111 patients (23.7%) achieved pCR while the other 469 patients showed residual disease. Patients with pCR had a lower pretreatment carcinoembryonic antigen level and earlier cT classification than those with residual disease. With a median follow-up of 78 months, disease-free survival (DFS) and overall survival (OS) were significantly better in the pCR group than in the residual disease group. The 5-year DFS and 5-year OS for patients with ypStage 0, I, II, or III were 92.5%, 85.1%, 72.2%, 54.3% (P < 0.001) and 94.5%, 91.0%, 83.1%, 69.3%, respectively (P < 0.001). Pathologic AJCC stage after CRT was the most statistically significant independent predictor of OS (HR, 6.97 [95% confidence interval, 3.16–15.39] for stage III vs. stage 0) and DFS (HR, 7.30 [95% confidence interval, 3.63–14.67] for stage III vs. stage 0).
Conclusion
Rectal cancer patients who achieved pCR showed improved survival compared to those with residual disease after preoperative CRT. Moreover, pCR was an independent indicator of OS and DFS, and pathologic AJCC stage was correlated with survival after preoperative CRT.

Citations

Citations to this article as recorded by  
  • Analysis of clinical and pathological prognostic factors of survival in rectal adenocarcinoma treated with preoperative radiochemotherapy
    Sarhan Sydney Saad, Nora Forones, Gaspar Lopes Filho, Jaques Waisberg, Elesiario Caetano Júnior, Ricardo Artigiani-Neto, Delcio Matos
    Acta Cirúrgica Brasileira.2025;[Epub]     CrossRef
  • Lateral pelvic lymph node dissection based on nodal response to neoadjuvant chemoradiotherapy in mid/low rectal cancer: a retrospective comparative cohort study
    Tae-Gyun Lee, Duck-Woo Kim, Hong-min Ahn, Hye-Rim Shin, Mi Jeong Choi, Min Hyeong Jo, Heung-Kwon Oh, Sung-Bum Kang
    Annals of Surgical Treatment and Research.2025; 108(6): 333.     CrossRef
  • Predicting Positive Radial Margin on Restaging MRI of Patients with Low Rectal Cancer: Can We Do Better?
    Anurima Patra, Aisha Lakhani, Antony Augustine, Priyanka Mohapatra, Anu Eapen, Ashish Singh, Dipti Masih, Thomas S. Ram, Mark R. Jesudason, Rohin Mittal, Anuradha Chandramohan
    Indian Journal of Radiology and Imaging.2024; 34(01): 85.     CrossRef
  • A Review of Neoadjuvant Therapy and the Watch-and-Wait Protocol in Rectal Cancer: Current Evidence and Future Directions
    Iulian M Slavu, Octavian Munteanu, Florin Filipoiu, Raluca Tulin, Anca Monica Macovei Oprescu , Ileana Dima, Iulian A Dogaru, Adrian Tulin
    Cureus.2024;[Epub]     CrossRef
  • Significant Pathologic Response Following Neoadjuvant Therapy and Curative Resection in Patients With Rectal Cancer: Surgical and Oncological Outcomes From a Retrospective Cohort Study
    Fatemeh Shahabi, Majid Ansari, Khadijeh Najafi Ghobadi, Abolfazl Ghahramani, Amiresmaeil Parandeh, Maryam Saberi‐Karimian, Ala Orafaie, Abbas Abdollahi
    Cancer Reports.2024;[Epub]     CrossRef
  • Clinical Implication of Lateral Pelvic Lymph Node Metastasis in Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy
    In Ja Park
    The Ewha Medical Journal.2022; 45(1): 3.     CrossRef
  • Multidisciplinary treatment strategy for early rectal cancer
    Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
    Precision and Future Medicine.2022; 6(1): 32.     CrossRef
  • Watch and wait strategies for rectal cancer: A systematic review
    In Ja Park
    Precision and Future Medicine.2022; 6(2): 91.     CrossRef
  • Patient Survival With ypT0N+ Following Neoadjuvant Therapy in Rectal Cancer
    Mohamedraed Elshami, Robert N. Goldstone, Lawrence S. Blaszkowsky, James C. Cusack, Theodore S. Hong, Jennifer Y. Wo, Motaz Qadan
    Diseases of the Colon & Rectum.2022; 65(10): 1224.     CrossRef
  • Neoadjuvant Radiotherapy Dose Escalation in Locally Advanced Rectal Cancer: a Systematic Review and Meta-analysis of Modern Treatment Approaches and Outcomes
    N. Hearn, D. Atwell, K. Cahill, J. Elks, D. Vignarajah, J. Lagopoulos, M. Min
    Clinical Oncology.2021; 33(1): e1.     CrossRef
  • Can normalized carcinoembryonic antigen following neoadjuvant chemoradiation predict tumour recurrence after curative resection for locally advanced rectal cancer?
    Youngki Hong, Amandeep Ghuman, Keat Seong Poh, Dimitri Krizzuk, Arun Nagarajan, Sudha Amarnath, Juan J. Nogueras, Steven D. Wexner, Giovanna DaSilva
    Colorectal Disease.2021; 23(6): 1346.     CrossRef
  • Omission of or Poor Response to Preoperative Chemoradiotherapy Impacts Radial Margin Positivity Rates in Locally Advanced Rectal Cancer
    Ana Sofia Ore, Gabrielle E. Dombek, Carlos A. Cordova-Cassia, Jeanne F. Quinn, Thomas E. Cataldo, Benjamin L. Schlechter, Matthew J. Abrams, Evangelos Messaris
    Diseases of the Colon & Rectum.2021; 64(6): 669.     CrossRef
  • Optimal Postoperative Surveillance Strategies for Colorectal Cancer: A Retrospective Observational Study
    Min-Young Park, In-Ja Park, Hyo-Seon Ryu, Jay Jung, Min-Sung Kim, Seok-Byung Lim, Chang-Sik Yu, Jin-Cheon Kim
    Cancers.2021; 13(14): 3502.     CrossRef
  • Evaluating the benefit of adjuvant chemotherapy in patients with ypT0–1 rectal cancer treated with preoperative chemoradiotherapy
    Ye Won Jeon, In Ja Park, Jeong Eun Kim, Jin-Hong Park, Seok-Byung Lim, Chan Wook Kim, Yong Sik Yoon, Jong Lyul Lee, Chang Sik Yu, Jin Cheon Kim
    World Journal of Gastrointestinal Surgery.2021; 13(9): 1000.     CrossRef
  • Comparison between Local Excision and Radical Resection for the Treatment of Rectal Cancer in ypT0-1 Patients: An Analysis of the Clinicopathological Factors and Survival Rates
    Soo Young Oh, In Ja Park, Young IL Kim, Jong-Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
    Cancers.2021; 13(19): 4823.     CrossRef
  • Neoadjuvant radiotherapy dose escalation for locally advanced rectal cancers in the new era of radiotherapy: A review of literature
    Durim Delishaj, Ilaria Costanza Fumagalli, Stefano Ursino, Agostino Cristaudo, Francesco Colangelo, Antonio Stefanelli, Alessandro Alghisi, Giuseppe De Nobili, Romerai D’Amico, Alessandra Cocchi, Antonio Ardizzoia, Carlo Pietro Soatti
    World Journal of Clinical Cases.2021; 9(30): 9077.     CrossRef
  • Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer: A Single-Center Experience and Literature Review
    Min Chul Kim, Jae Hwan Oh
    Annals of Coloproctology.2021; 37(6): 382.     CrossRef
  • Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
    Eun Jung Park, Seung Hyuk Baik
    Precision and Future Medicine.2021; 5(4): 164.     CrossRef
  • From Total Mesorectal Excision to Organ Preservation for the Treatment of Rectal Cancer
    Seong Kyu Baek
    Annals of Coloproctology.2019; 35(2): 51.     CrossRef
Transanal Endoscopic and Transabdominal Robotic Total Mesorectal Excision for Mid-to-Low Rectal Cancer: Comparison of Short-term Postoperative and Oncologic Outcomes by Using a Case-Matched Analysis
Ki Young Lee, Jung Kyoung Shin, Yoon Ah Park, Seong Hyeon Yun, Jung Wook Huh, Yong Beom Cho, Hee Cheol Kim, Woo Yong Lee
Ann Coloproctol. 2018;34(1):29-35.   Published online February 28, 2018
DOI: https://doi.org/10.3393/ac.2018.34.1.29
  • 6,899 View
  • 114 Download
  • 21 Web of Science
  • 19 Citations
AbstractAbstract PDF
Purpose

This study aimed to compare short-term postoperative and oncologic outcomes of a transanal endoscopic total mesorectal excision (TME) to those of a transabdominal robotic TME.

Methods

A total of 62 patients with rectal cancer underwent transanal (n = 26) or robotic (n = 36) TME between June 2013 and December 2014. After case-matching by tumor location and TNM stage, 45 patients were included for analysis. The median follow-up period was 21.3 months. Operative, histopathologic and postoperative outcomes and recurrences were analyzed.

Results

Patients younger than 60 years of age were more frequently observed in the robotic TME group (75.0% vs. 47.6%, P = 0.059), but tumor location, cT and cN category, and preoperative chemoradiotherapy were not different between the 2 groups. Estimated blood loss was greater in the transanal group (283 mL vs. 155 mL, P = 0.061); however, the operation time and the rate of a diverting ileostomy and subsequent ileostomy repair were not different between the groups. The proximal resection margin was longer in the transanal TME group (20.8 cm ± 16.0 cm, P = 0.030), but the distal resection margins, involvements of the circumferential resection margin, TME quality, numbers of retrieved lymph nodes, postoperative complications, including anastomotic leak and voiding difficulty, and recurrence rates for the 2 groups were not statistically different.

Conclusion

Transanal endoscopic and transabdominal robotic TME showed similar histopathologic and postoperative outcomes with the exception of the estimated blood loss and the proximal resection margin for a select group of patients.

Citations

Citations to this article as recorded by  
  • Systematic review and meta-analysis comparing robotic total mesorectal excision versus transanal total mesorectal excision for rectal cancer
    Mohamed Ali Chaouch, Mohammad Iqbal Hussain, Maissa Jellali, Amine Gouader, Alessandro Mazzotta, Adriano Carneiro da Costa, Bassem Krimi, Jim Khan, Hani Oweira
    Scandinavian Journal of Surgery.2025; 114(1): 73.     CrossRef
  • Peri-operative, oncological and functional outcomes of robotic versus transanal total mesorectal excision in patients with rectal cancer: A systematic review and meta-analysis
    A. Y. Y. Mohamedahmed, S. Zaman, A. A. Wuheb, A. Ismail, M. Nnaji, A. A. Alyamani, H. A. Eltyeb, N. A. Yassin
    Techniques in Coloproctology.2024;[Epub]     CrossRef
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    Du Yong Gang, Lin Dong, Zhang DeChun, Zhang Yichi, Lu Ya
    Frontiers in Oncology.2023;[Epub]     CrossRef
  • Robotic-assisted laparoscopic low anterior resection versus trans-anal total mesorectal excision for malignant rectal lesion: a prospective cohort trial
    Ahmed F.A. Farag, Ahmed M.A. Mahmoud, Haitham M. Azmy, Abdrabbou N. Mashhour, Ahmed S. Khalifa, Yasser Debakey, Mohamed Y. Elbarmelgi
    The Egyptian Journal of Surgery.2023; 42(4): 859.     CrossRef
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    Yusuke Inoue, Jing Yu Ng, Chun-Ho Chu, Yi-Ling Lai, I.-Ping Huang, Shung-Haur Yang, Chien-Chih Chen
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    Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
    Precision and Future Medicine.2022; 6(1): 32.     CrossRef
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    Jung Kyong Shin, Hee Cheol Kim, Seong Hyeon Yun, Yoon Ah Park, Yong Beom Cho, Jung Wook Huh, Woo Yong Lee
    Surgical Endoscopy.2021; 35(12): 6998.     CrossRef
  • Statistical, Clinical, Methodological Evaluation of Local Recurrence Following Transanal Total Mesorectal Excision for Rectal Cancer: A Systematic Review
    Hans H. Wasmuth, Mahir Gachabayov, Les Bokey, Abe Fingerhut, Guy R. Orangio, Feza H. Remzi, Roberto Bergamaschi
    Diseases of the Colon & Rectum.2021; 64(7): 899.     CrossRef
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