Is preoperative chemoradiotherapy necessary for all patients with upper rectal cancer: One center retrospective study

Abstract

Abstract Background In present time, neoadjuvant chemoradiotherapy for distal rectal cancer is part of clinical guidelines in Europe and the USA. According to the literature, there are no unified standards for upper rectal cancer. Methods The study included data from patients over 18 years old, with histologically proven adenocarcinoma with TNM stage T2-4aN0-2M0 and tumour location in the upper part of the rectum (10-15 sm). In the main group (A), preoperative chemoradiotherapy was performed: short-course radiotherapy (5x5\u2009Gy), with capecitabine 2000\u2009mg/m2 × 2 times for 14 days, followed by surgical treatment. In the control group (B) only surgical treatment was performed - partial or total mesorectumectomy. Results From January 2004 to December 2014, 226 (99.6%) underwent surgical treatment. The incidence of postoperative complications byClavien-Dindo scale was:group A - 17 (16.5%) and group B - 11 (8.9%). Local recurrences in group A occurred in 1 patient (1.2%), in group B - in 3 (2.5%) patients (p\u2009=\u20090.413). Distant metastases in group A developed in 10 (10.2%) patients, in group B -15 (12.6%) patients (p\u2009=\u20090.581). Overall survival was in group A - 90.6%, recurrence-free - 89.6%; in group B - 82.8% and 81.9%, respectively (p\u2009=\u20090.46). Multivariate analysis showed that the affected regional lymph nodes were the main predictor of poor prognosis (p\u2009=\u20090.001, OR\u2009=\u20090.094, CI\u2009=\u20090.035-0.250) and significantly reduced the 5-year disease-free survival rate (p\u2009=\u20090.001, OR\u2009=\u20094.213, CI\u2009=\u20092.010-8.830). Conclusions The results of the study showed that neoadjuvant chemoradiotherapy in comparison with the surgical method does not have an advantage for patients with upper rectum cancer. Legal entity responsible for the study Jasur Madyarov. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.