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An Interval >7 Weeks between Neoadjuvant Therapy and Surgery Improves Pathologic Complete Response and Disease–Free Survival in Patients with Locally Advanced Rectal Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We assessed whether the time interval between neoadjuvant therapy and surgery affects the operative and postoperative morbidity and mortality, the pathologic complete response (pCR) rate, and disease recurrence in locally advanced rectal cancer.

Methods

One–hundred and thirty-two patients with locally advanced low– and mid–rectal cancer underwent neoadjuvant chemoradiation followed by radical resection (October 2000 to December 2006). Data on the neoadjuvant regime, neoadjuvant–surgery interval, final pathology, type of operation, operative time, intraoperative blood transfusions, postoperative complications, length of hospital stay, disease recurrence, and mortality were reviewed. The patients were divided into two groups according to the neoadjuvant–surgery interval: ≤7 weeks (group A, n = 48), and >7 weeks (group B, n = 84).

Results

The groups were demographically comparable except for the group A patients being younger at operation. The median interval between chemoradiation and surgery was 56 days (range 13–173 days). Thirty-seven patients (28%) had a pCR and near pCR. Fifty three patients (40%) had complications. There was no in-hospital mortality. Surgery type, operative time, number of intraoperative blood transfusions, postoperative complications, and length of hospitalization were not influenced by the interval length. The pCR and near pCR rates were higher with longer interval: 17% in group A, 35% in group B (P = 0.03). Patients operated at an interval >7 weeks had significantly better disease–free survival (P = 0.05).

Conclusions

A neoadjuvant–surgery interval >7 weeks was associated with higher rates of pCR and near pCR, decreased recurrence and improved disease–free survival.

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Acknowledgement

Esther Eshkol is thanked for editorial assistance.

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Authors and Affiliations

  1. Proctology Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Hagit Tulchinsky MD & Micha Rabau MD

  2. Department of Surgery “B”, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Hagit Tulchinsky MD, Joseph M. Klausner MD & Micha Rabau MD

  3. Department of Oncology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Einat Shmueli MD & Arie Figer MD

Authors
  1. Hagit Tulchinsky MD
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  2. Einat Shmueli MD
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  3. Arie Figer MD
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  4. Joseph M. Klausner MD
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  5. Micha Rabau MD
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Correspondence to Hagit Tulchinsky MD.

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Tulchinsky, H., Shmueli, E., Figer, A. et al. An Interval >7 Weeks between Neoadjuvant Therapy and Surgery Improves Pathologic Complete Response and Disease–Free Survival in Patients with Locally Advanced Rectal Cancer. Ann Surg Oncol 15, 2661–2667 (2008). https://doi.org/10.1245/s10434-008-9892-3

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  • DOI: https://doi.org/10.1245/s10434-008-9892-3

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