Annals of Coloproctology (Jun 2023)

Efficacy of preoperative chemoradiotherapy in patients with cT2N0 distal rectal cancer

  • Min Young Park,
  • Chang Sik Yu,
  • Tae Won Kim,
  • Jong Hoon Kim,
  • Jin-hong Park,
  • Jong Lyul Lee,
  • Yong Sik Yoon,
  • In Ja Park,
  • Seok-Byung Lim,
  • Jin Cheon Kim

DOI
https://doi.org/10.3393/ac.2022.00066.0009
Journal volume & issue
Vol. 39, no. 3
pp. 250 – 259

Abstract

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Purpose This study was designed to determine the feasibility of preoperative chemoradiotherapy (PCRT) in patients with clinical T2N0 distal rectal cancer. Methods Patients who underwent surgery for clinical T2N0 distal rectal cancer between January 2008 and December 2016 were included. Patients were divided into PCRT and non-PCRT groups. Non-PCRT patients underwent radical resection or local excision (LE) according to the surgeon’s decision, and PCRT patients underwent surgery according to the response to PCRT. Patients received 50.0 to 50.4 gray of preoperative radiotherapy with concurrent chemotherapy. Results Of 127 patients enrolled, 46 underwent PCRT and 81 did not. The mean distance of lesions from the anal verge was lower in the PCRT group (P=0.004). The most frequent operation was transanal excision and ultralow anterior resection in the PCRT and non-PCRT groups, respectively. Of the 46 patients who underwent PCRT, 21 (45.7%) achieved pathologic complete response, including 15 of the 24 (62.5%) who underwent LE. Rectal sparing rate was significantly higher in the PCRT group (11.1% vs. 52.2%, P<0.001). There were no significant differences in 3- and 5-year overall survival and recurrence-free survival regardless of PCRT or surgical procedures. Conclusion PCRT in clinical T2N0 distal rectal cancer patients increased the rectal sparing rate via LE and showed acceptable oncologic outcomes. PCRT may be a feasible therapeutic option to avoid abdominoperineal resection in clinical T2N0 distal rectal cancer.

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