The Shifting and Evolving Neoadjuvant Treatments and Surgical Platforms on Oncological Outcomes and Sphincter Preservation in Distal Rectal Cancer: A 23-Year Retrospective Experience.
{"title":"The Shifting and Evolving Neoadjuvant Treatments and Surgical Platforms on Oncological Outcomes and Sphincter Preservation in Distal Rectal Cancer: A 23-Year Retrospective Experience.","authors":"Niyaz Shadmanov, Vusal Aliyev, Barıs Bakır, Suha Goksel, Oktar Asoglu","doi":"10.1007/s12029-025-01303-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to evaluate how advancements in surgical technology and evolving neoadjuvant treatment (NAT) protocols have influenced clinical, pathological, and long-term oncological outcomes in patients with locally advanced distal rectal cancer (LADRC). Particular emphasis is placed on how the evolving practice of a single high-volume colorectal surgeon has mirrored these developments over a 23-year period.</p><p><strong>Methods: </strong>This retrospective cohort included 561 patients with LADRC who underwent NAT between 2001 and 2024. Patients were stratified into two groups based on the year 2013, which marked the institutional adoption of robotic surgery, high-resolution 3-Tesla MRI, and the formal implementation of the Watch-and-Wait (W&W) strategy: Group I (2001-2012) and Group II (2013-2024).</p><p><strong>Results: </strong>The median follow-up duration was significantly longer in Group 1 (191 ± 2.29 months) compared to Group 2 (71 ± 2.81 months). Local recurrence (LR) occurred in 11.6% of patients in Group 1 and 6.9% in Group 2 (p = 0.107), while distant metastasis (DM) was observed in 15.5% and 10.6%, respectively (p = 0.178) (Fig. 2). Disease-free survival (DFS) at 5 years was 67.4% (95% CI: 58.6-74.8) in Group 1 and 80.1% (95% CI: 75.6-83.8) in Group 2 (p = 0.003). At 10 years, DFS was 65.2% (95% CI: 58.6-74.8) and 79.4% (95% CI: 74.7-83.3) in Groups 1 and 2, respectively (p = 0.006). Similarly, overall survival (OS) at 5 years was 78.0% (95% CI: 67.6-82.4) in Group 1 and 91.7% (95% CI: 87.9-93.3) in Group 2 (p < 0.001). At 10 years, OS was 73.4% (95% CI: 66.0-81.1) and 90.5% (95% CI: 87.3-92.9), respectively (p < 0.001). Additionally, permanent stoma-free survival (PSFS) improved significantly over time, from 56.5% in Group 1 to 85.8% in Group 2 (p < 0.001).</p><p><strong>Conclusion: </strong>The integration of robotic surgery, high-resolution MRI, and the W&W strategy has significantly improved oncological outcomes and sphincter preservation rates in patients with LADRC over the past two decades.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"56 1","pages":"177"},"PeriodicalIF":1.6000,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Gastrointestinal Cancer","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12029-025-01303-y","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: This study aims to evaluate how advancements in surgical technology and evolving neoadjuvant treatment (NAT) protocols have influenced clinical, pathological, and long-term oncological outcomes in patients with locally advanced distal rectal cancer (LADRC). Particular emphasis is placed on how the evolving practice of a single high-volume colorectal surgeon has mirrored these developments over a 23-year period.
Methods: This retrospective cohort included 561 patients with LADRC who underwent NAT between 2001 and 2024. Patients were stratified into two groups based on the year 2013, which marked the institutional adoption of robotic surgery, high-resolution 3-Tesla MRI, and the formal implementation of the Watch-and-Wait (W&W) strategy: Group I (2001-2012) and Group II (2013-2024).
Results: The median follow-up duration was significantly longer in Group 1 (191 ± 2.29 months) compared to Group 2 (71 ± 2.81 months). Local recurrence (LR) occurred in 11.6% of patients in Group 1 and 6.9% in Group 2 (p = 0.107), while distant metastasis (DM) was observed in 15.5% and 10.6%, respectively (p = 0.178) (Fig. 2). Disease-free survival (DFS) at 5 years was 67.4% (95% CI: 58.6-74.8) in Group 1 and 80.1% (95% CI: 75.6-83.8) in Group 2 (p = 0.003). At 10 years, DFS was 65.2% (95% CI: 58.6-74.8) and 79.4% (95% CI: 74.7-83.3) in Groups 1 and 2, respectively (p = 0.006). Similarly, overall survival (OS) at 5 years was 78.0% (95% CI: 67.6-82.4) in Group 1 and 91.7% (95% CI: 87.9-93.3) in Group 2 (p < 0.001). At 10 years, OS was 73.4% (95% CI: 66.0-81.1) and 90.5% (95% CI: 87.3-92.9), respectively (p < 0.001). Additionally, permanent stoma-free survival (PSFS) improved significantly over time, from 56.5% in Group 1 to 85.8% in Group 2 (p < 0.001).
Conclusion: The integration of robotic surgery, high-resolution MRI, and the W&W strategy has significantly improved oncological outcomes and sphincter preservation rates in patients with LADRC over the past two decades.
期刊介绍：
The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
