title: Prognostic factors for low rectal cancer patients undergoing intersphincteric resection after neoadjuvant chemoradiation.
abstract: OBJECTIVE
  This study aimed to investigate prognostic factors for low rectal cancer patients undergoing intersphincteric resection (ISR) following neoadjuvant chemoradiation (CRT).
  
  
  METHODS
  We retrospectively reviewed 163 primary rectal cancer patients without distant metastasis who underwent ISR following neoadjuvant CRT between January 2006 and December 2011. Prognostic factors for disease-free survival (DFS) and local recurrence-free survival (LRFS) were evaluated.
  
  
  RESULTS
  The median follow-up period was 53 months (range, 0-82 months). Kaplan-Meier survival analysis indicated different 3-year DFS (stage 0, 96.2%; I, 84.8%; II, 72.9%; III, 38.0%) and 3-year LRFS (stage 0, 100.0%; I, 92.4%; II, 91.1%; III, 70.9%) according to pathologic TNM stages, particularly stage III. Multivariable Cox regression analysis suggested that DFS was associated with ypT (3/4 vs. 0/1/2) and ypN (1/2 vs. 0) stages, whereas LRFS with ypN stage (1/2 vs. 0), tumor size (≥3.5 cm vs. <3.5 cm), and tumor height from the anal verge (≤2 cm vs. >2 cm).
  
  
  CONCLUSIONS
  ISR following CRT could be feasible in stage-I and II low rectal cancer patients, but might be related to poor oncologic outcomes in those with stage-III disease. The indication for ISR or abdominoperineal resection should be carefully evaluated in cases of low rectal cancer with suspicious lymph node metastasis after CRT.
authors.affiliation: Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea.
authors.forename: Soo Young
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea.
authors.forename: Jeong Seon
authors.initials: JS
authors.lastname: Jo
authors.affiliation: Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea.
authors.forename: Hun Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea.
authors.forename: Chang Hyun
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea.
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea.
authors.forename: Hyeong Rok
authors.initials: HR
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: chemoradiation; intersphincteric resection; prognosis; rectal cancer; recurrence