Ann Surg Treat Res.  2022 Aug;103(2):87-95. 10.4174/astr.2022.103.2.87.

Impact of circumferential tumor location of mid to low rectal cancer on oncologic outcomes after preoperative chemoradiotherapy

Affiliations
  • 1Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea

Abstract

Purpose
Some studies have suggested that circumferential tumor location (CTL) of rectal cancer may affect oncological outcomes. However, studies after preoperative chemoradiotherapy (CRT) are rare. This study aimed to evaluate the impact of CTL on oncologic outcomes of patients with mid to low rectal cancer who received preoperative CRT.
Methods
Patients with mid to low rectal cancer who underwent total mesorectal excision after CRT from January 2013 to December 2018 were included in this retrospective study. The impact of CTL on the pathological circumferential resection margin (CRM) status, local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) was analyzed.
Results
Of the 381 patients, 98, 70, 127, and 86 patients were categorized into the anterior, posterior, lateral, and circumferential tumor groups, respectively. Tumor location was not significantly associated with the pathological CRM involvement (anterior, 12.2% vs. posterior, 14.3% vs. lateral, 11.0% vs. circumferential, 17.4%; P = 0.232). Univariate analyses revealed no correlation between CTL and 3-year LRFS (93.0% vs. 89.1% vs. 91.5% vs. 88%, P = 0.513), 3-year DFS (70.3% vs. 70.2% vs. 75.3% vs. 75.7%, P = 0.832), and 5-year OS (74.7% vs. 78.0% vs. 83.9% vs. 78.2%, P = 0.204). Multivariate analysis identified low rectal cancer and pathological CRM involvement as independent risk factors for all survival outcomes (all P < 0.05).
Conclusion
CTL of rectal cancer after preoperative CRT was not significantly associated with the pathological CRM status, recurrence, and survival.

Keyword

Chemoradiotherapy; Neoadjuvant therapy; Rectal neoplasms; Surgery; Treatment outcome

Figure

  • Fig. 1 MRIs showing the location of the deepest tumor infiltration. (A) Anterior, (B) posterior, (C) lateral, and (D) circumferential.

  • Fig. 2 Flow diagram for patient inclusion. TME, total mesorectal excision; CRT, chemoradiotherapy.

  • Fig. 3 Survival outcomes related to circumferential tumor location. (A) Local recurrence-free survival, (B) disease-free survival, and (C) overall survival.


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