Delaying surgery after neoadjuvant chemoradiotherapy improves prognosis of rectal cancer.
OBJECTIVE
To investigate the prognostic effect of a delayed interval between neoadjuvant chemoradiotherapy (CRT) and surgery in locally advanced rectal cancer.


METHODS
We evaluated 87 patients with locally advanced mid- or distal rectal cancer undergoing total mesorectal excision following an interval period after neoadjuvant CRT at Şişli Hamidiye Etfal Training and Research Hospital, Istanbul between January 2009 and January 2014. Patients were divided into two groups according to the interval before surgery: < 8 wk (group I) and ≥ 8 wk (group II). Data related to patients, cancer characteristics and pathological examination were collected and analyzed.


RESULTS
When the distribution of timing between group I (n = 45) and group II (n = 42) was viewed, comparison of interval periods (median ± SD) of groups showed a significant difference of as 5 ± 1.28 wk in group I and 10.1 ± 2.2 wk in group II (P < 0.001). The median follow-up period for all patients was 34.5 (9.9-81) mo. group II had significantly higher rates of pathological complete response (pCR) than group I had (19% vs 8.9%, P = 0.002). Rate of tumor regression grade (TRG) poor response was 44.4% in group I and 9.5% in group II (P < 0.002). A poor pathological response was associated with worse disease-free survival (P = 0.009). The interval time did not show any association with local recurrence (P = 0.79).


CONCLUSIONS
Delaying the neoadjuvant CRT-surgery interval may provide nodal down-staging, improve pCR rate, and decrease the rate of TRG poor response.
Mehmet Mihmanlı, Esin Kabul Gürbulak, İsmail Ethem Akgün, Mustafa Fevzi Celayir, Pınar Yazıcı, Ayhan Öz, Sinan Ömeroğlu, Department of General Surgery, Şişli Etfal Training and Research Hospital, Şişli 34371, Istanbul, Turkey.
Mehmet
M
Mihmanlı
Mehmet Mihmanlı, Esin Kabul Gürbulak, İsmail Ethem Akgün, Mustafa Fevzi Celayir, Pınar Yazıcı, Ayhan Öz, Sinan Ömeroğlu, Department of General Surgery, Şişli Etfal Training and Research Hospital, Şişli 34371, Istanbul, Turkey.
Esin
E
Kabul Gürbulak
Mehmet Mihmanlı, Esin Kabul Gürbulak, İsmail Ethem Akgün, Mustafa Fevzi Celayir, Pınar Yazıcı, Ayhan Öz, Sinan Ömeroğlu, Department of General Surgery, Şişli Etfal Training and Research Hospital, Şişli 34371, Istanbul, Turkey.
İsmail Ethem
İE
Akgün
Mehmet Mihmanlı, Esin Kabul Gürbulak, İsmail Ethem Akgün, Mustafa Fevzi Celayir, Pınar Yazıcı, Ayhan Öz, Sinan Ömeroğlu, Department of General Surgery, Şişli Etfal Training and Research Hospital, Şişli 34371, Istanbul, Turkey.
Mustafa Fevzi
MF
Celayir
Mehmet Mihmanlı, Esin Kabul Gürbulak, İsmail Ethem Akgün, Mustafa Fevzi Celayir, Pınar Yazıcı, Ayhan Öz, Sinan Ömeroğlu, Department of General Surgery, Şişli Etfal Training and Research Hospital, Şişli 34371, Istanbul, Turkey.
Pınar
P
Yazıcı
Mehmet Mihmanlı, Esin Kabul Gürbulak, İsmail Ethem Akgün, Mustafa Fevzi Celayir, Pınar Yazıcı, Ayhan Öz, Sinan Ömeroğlu, Department of General Surgery, Şişli Etfal Training and Research Hospital, Şişli 34371, Istanbul, Turkey.
Deniz
D
Tunçel
Mehmet Mihmanlı, Esin Kabul Gürbulak, İsmail Ethem Akgün, Mustafa Fevzi Celayir, Pınar Yazıcı, Ayhan Öz, Sinan Ömeroğlu, Department of General Surgery, Şişli Etfal Training and Research Hospital, Şişli 34371, Istanbul, Turkey.
Tuba Tülin
TT
Bek
Mehmet Mihmanlı, Esin Kabul Gürbulak, İsmail Ethem Akgün, Mustafa Fevzi Celayir, Pınar Yazıcı, Ayhan Öz, Sinan Ömeroğlu, Department of General Surgery, Şişli Etfal Training and Research Hospital, Şişli 34371, Istanbul, Turkey.
Ayhan
A
Öz
Mehmet Mihmanlı, Esin Kabul Gürbulak, İsmail Ethem Akgün, Mustafa Fevzi Celayir, Pınar Yazıcı, Ayhan Öz, Sinan Ömeroğlu, Department of General Surgery, Şişli Etfal Training and Research Hospital, Şişli 34371, Istanbul, Turkey.
Sinan
S
Ömeroğlu
Interval timing; Neoadjuvant chemoradiotherapy; Pathological tumor response; Rectal carcinoma; Tumor down-staging
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