The role of postoperative chemotherapy in patients who undergoing surgery following chemoradiotherapy of initially unresectable rectal cancer

Abstract

Introduction. Preoperative chemoradiotherapy (preCRT) improves local control of rectal cancer and such is parti­cularly merited for treating locoregionally advanced tumors. Nevertheless, the role of postoperative chemotherapy (postCT) in such patients is currently disputed. Materials. Subjects were 75 patients with unresectable cT3–4 and/or N+ tumors who underwent radical surgery following preCRT between January 2003 and December 2012 at the Oncology Centre in Bydgoszcz. PostCT was subsequently used in 32 (43%) of these patients. Results. There were 20 abdominoperineal resections (APR), 50 anterior resections (AR) and 5 Hartmann’s procedures (HART) performed in the patient group, where respectively 30%, 46% and 60%, received systemic treatment. Based on postoperative histopathological assessment, disease staging was assigned as follows: stage III for 32 (43%), patient­s,stage II for 22 (29%) and stage I for 15 (20%). Pathologic complete pathological response (pCR) was seen in 6 cases (8%). In the postCT+ group, disease stage III was observed in 13 (41%) patients. A three-year survival was observed in 43 patients; 25 (58%) and 18 (56%) of patients respectively undergoing either postCT– or postCT+. A five-year survival was noted in 26 patients; 19 (44%) and 7 (22%) in both groups, respectively. Conclusion. Together with the most recent reports, our study demonstrates that postoperative chemotherapy has no significant effect on the outcomes of oncological treatment in those patients having undergone preoperative chemoradiotherapy for locoregionally advanced rectal cancer.