title: Does Delaying Surgical Resection After Neoadjuvant Chemoradiation Impact Clinical Outcomes in Locally Advanced Rectal Adenocarcinoma?: A Single-Institution Experience.
abstract: Surgical resection for locally advanced rectal adenocarcinoma commonly occurs 6 to 10 weeks after completion of neoadjuvant chemoradiation (nCRT). We sought to determine the optimal timing of surgery related to the pathologic complete response rate and survival endpoints.
  
  
  
  The study is a retrospective analysis of 92 patients treated with nCRT followed by surgery from 2004 to 2011 at our institution. Univariate and multivariate analyses were performed to assess the impact of timing of surgery on locoregional control, distant failure (DF), disease-free survival, and overall survival (OS).
  
  
  
  Time-to-surgery was ≤8 weeks (group A) in 72% (median 6.1 wk) and >8 weeks (group B) in 28% (median 8.9 wk) of patients. No significant differences in patient characteristics, locoregional control, or pathologic complete response rates were noted between the groups. Univariate analysis revealed that group B had significantly shorter time to DF (group B, median 33 mo; group A, median not reached, P=0.047) and shorter OS compared with group A (group B, median 52 mo; group A, median not reached, P=0.03). Multivariate analysis revealed that increased time-to-surgery showed a significant increase in DF (HR=2.96, P=0.02) and trends toward worse OS (HR=2.81, P=0.108) and disease-free survival (HR=2.08, P=0.098).
  
  
  
  We found that delaying surgical resection longer than 8 weeks after nCRT was associated with an increased risk of DF. This study, in combination with a recent larger study, questions the recent trend in promoting surgical delay beyond the traditional 6 to 10 weeks. Larger, prospective databases or randomized studies may better clarify surgical timing following nCRT in rectal adenocarcinoma.
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Phuong
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Evan
authors.initials: E
authors.lastname: Wuthrick
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Chablani
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Andrew
authors.initials: A
authors.lastname: Robinson
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Luke
authors.initials: L
authors.lastname: Simmons
authors.affiliation: Internal Medicine, Division of Medical Oncology.
authors.forename: Christina
authors.initials: C
authors.lastname: Wu
authors.affiliation: Surgery, Division of Colon and Rectal Surgery.
authors.forename: Mark
authors.initials: M
authors.lastname: Arnold
authors.affiliation: Surgery, Division of Colon and Rectal Surgery.
authors.forename: Alan E
authors.initials: AE
authors.lastname: Harzman
authors.affiliation: Surgery, Division of Colon and Rectal Surgery.
authors.forename: Syed
authors.initials: S
authors.lastname: Husain
authors.affiliation: Surgical Oncology, The Ohio State University, Columbus, OH.
authors.forename: Carl
authors.initials: C
authors.lastname: Schmidt
authors.affiliation: Surgical Oncology, The Ohio State University, Columbus, OH.
authors.forename: Sherif
authors.initials: S
authors.lastname: Abdel-Misih
authors.affiliation: Internal Medicine, Division of Medical Oncology.
authors.forename: Tanios
authors.initials: T
authors.lastname: Bekaii-Saab
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Arnab
authors.initials: A
authors.lastname: Chakravarti
authors.affiliation: Departments of Radiation Oncology.
authors.forename: Terence M
authors.initials: TM
authors.lastname: Williams
mesh_terms: D000046:Academic Medical Centers; D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000379:methods; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D000078542:Proctectomy / Q000379:methods* / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome