Shinsuke Masubuchi1, Tetsuji Terazawa2, Keitaro Tanaka1, Masashi Yamamoto1, Masatsugu Ishii1, Yoshihiro Inoue1, Takayuki Ki2, Masahiro Goto2, Junji Okuda3, Kazuhisa Uchiyama1. 1Department of General and Gastroenterological Surgery, Osaka Medical College, 2Department of Cancer Chemotherapy Center, Osaka Medical College, 3Department of Cancer Center, Osaka Medical College
Total mesorectal excision(TME) with neoadjuvant chemoradiotherapy (NACRT) is standard treatment for rectal cancer, which has resulted in a decrease in local recurrence. However, NACRT has shown no significant overall survival and some adverse effects mainly caused by radiation therapy. Recently, the usefulness of neoadjuvant chemotherapy (NAC) has been reported. We retrospectively assessed the efficacy and safety of the neoadjuvant mFOLFOXIRI compared with NACRT followed by laparoscopic surgery.
A total of 76 patients undergoing laparoscopic surgery for lower rectal cancer (clinical Stage:II or III) from July 2014 to February 2017 in our department were retrospectively evaluated. 40 patients underwent NAC, and 36 patients underwent NACRT. The following data were collected: pathological complete response (pCR), histological grade, down staging, radial margin (RM) and postoperative complications. Histological grade was defined as follows : tumor cell necrosis or degeneration is present in less than one third of the tumor area(Grade1a), between one and two thirds(Grade 1b), more than two thirds but viable cells remain(Grade 2), and complete response (Grade 3).
These two groups were demographically comparable. Down staging did not differ between the two groups. Histological grade (?Grade 1b) and pCR were significantly higher in the NACRT than in the NAC group (p <0.05). RM had no significant difference in both groups, but tended to be able to secure negative RM in the NAC group (95% vs. 83.3%, p=0.06). There were no significant differences in complications (wound infection, pelvic abscess, ileus, urinary disturbance, urinary tract infection). However, NAC group reduced complications after stoma closure (0% vs. 17.4%; rectovaginal fistula:1, rectourethral fistula:2, ischemic enteritis:1, p <0.05).
Compared to NACRT, NAC was inferior in local control, but it was able to secure negative RM, and reduced complications after stoma closure. Neoadjuvant mFOLFOXIRI for locally advanced low rectal cancer seems to be promising. Long-term outcome should be evaluated in the near future.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86792
Program Number: P194
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster