ORIGINAL ARTICLE   

Minerva Chirurgica 2018 June;73(3):269-79

DOI: 10.23736/S0026-4733.18.07550-8

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Comparing outcomes after treatment of rectal cancer over a long-lasting follow-up between patients who were offered surgery alone and surgery with neoadjuvant therapy

Francesco GIUDICI ¹, Corrado R. ASTERIA ² ✉, Tatiana BARGELLINI ¹, Giovanni ALEMANNO ¹, Alessandro STURIALE ¹, Giuseppe LUCCHINI ³, Francesco TONELLI ¹

¹ Department of Surgery and Translational Medicine, School of Medicine, University of Florence, Florence, Italy; ² Department of Surgery and Orthopaedics, ASST Carlo Poma, Mantua, Italy; ³ Department of Healthcare Medical Management, Biostatistic Service, ASST Carlo Poma, Mantua, Italy

BACKGROUND: To assess outcomes of patients operated on for rectal cancer (RC) by analysing the trends of disease free survival curves (DFSc) after a very long-term follow-up.
METHODS: All patients treated with curative intent for RC from 1986 to 2005 were retrospectively analyzed. Other than demographics, disease characteristics and treatment-related factors were considered. The DFSc were compared between patients who had neoadjuvant therapy (NAT) and those who had surgery alone.
RESULTS: Median age of 319 patients included in the study was 66.3 years (range 23-89) and 140 (57.6%) of them were males. Moreover, NAT was given in 24 (11.8%) patients, and adjuvant therapy in 40 (19.7%) patients. Median follow-up was of 150 months (60-240). In patients who had NAT the mean age was higher (P=0.05), RC were located lower (P=0.009) and higher positive lymph-nodes were found (P=0.003), whereas the number of both local (P=0.4) and distant recurrences (P=0.7) was not significantly lower, compared to the other group. Comparing trends of DFSc a more progressive decrease was shown in patients treated with surgery alone. Even if the differences of DSFc between groups at the end of follow-up were not significant (95% CI: 0.609-2.963, P=0.46), patients who had NAT displayed better survival up to 180 months.
CONCLUSIONS: Overall, these results showed comparable outcomes between both groups over such a long lasting follow-up. This time frame might be used more extensively for increasing our knowledge of RC biological behaviour as well.

KEY WORDS: Rectal neoplasms - Outcome assessment (health care) - Neoadjuvant therapy