title: Pathologic response grade after long-course neoadjuvant chemoradiation does not influence morbidity in locally advanced mid-low rectal cancer resected by laparoscopy.
abstract: OBJECTIVE
  Patients with locally advanced rectal cancer and pathologic complete response to neoadjuvant chemoradiation therapy have lower rates of recurrence compared to those who do not. However, the influences of the pathologic response on surgical complications and survival remain unclear. This study aimed to investigate the influence of neoadjuvant therapy for rectal cancer on postoperative morbidity and long-term survival.
  
  
  METHODS
  This was a comparative study of consecutive patients who underwent laparoscopic total mesorectal excision for rectal cancer in two European tertiary hospitals between 2004 and 2014. Patients with and without pathologic complete responses were compared in terms of postoperative morbidity, mortality, and survival.
  
  
  RESULTS
  Fifty patients with complete response (ypT0N0) were compared with 141 patients who exhibited non-complete response. No group differences were observed in the postoperative mortality or morbidity rates. The median follow-up time was 57 months (range 1-121). Over this period, 11 (5.8 %) patients, all of whom were in the non-complete response group, exhibited local recurrence. The 5-year overall survival and disease-free survival were significantly better in the complete response group, 92.5 vs. 75.3 % (p = 0.004) and 89 vs. 73.4 % (p = 0.002), respectively.
  
  
  CONCLUSIONS
  Postoperative complication rate after laparoscopic total mesorectal excision is not associated with the pathologic response grade to neoadjuvant chemoradiation therapy.
authors.affiliation: Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France. pippo.landi@gmail.com.|Unit of Colorectal Surgery, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain. pippo.landi@gmail.com.|Universidad Autonoma de Barcelona UAB, Barcelona, Spain. pippo.landi@gmail.com.
authors.forename: Filippo
authors.identifier: http://orcid.org/0000-0002-8836-6466
authors.initials: F
authors.lastname: Landi
authors.affiliation: Unit of Colorectal Surgery, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.|Universidad Autonoma de Barcelona UAB, Barcelona, Spain.
authors.forename: Eloy
authors.initials: E
authors.lastname: Espín
authors.affiliation: Unit of Colorectal Surgery, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.|Universidad Autonoma de Barcelona UAB, Barcelona, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Rodrigues
authors.affiliation: Unit of Colorectal Surgery, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.|Universidad Autonoma de Barcelona UAB, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Vallribera
authors.affiliation: Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France.
authors.forename: Aleix
authors.initials: A
authors.lastname: Martinez
authors.affiliation: Department of Pathology. Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, Creteil, France.
authors.forename: Cecile
authors.initials: C
authors.lastname: Charpy
authors.affiliation: Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France.
authors.forename: Francesco
authors.initials: F
authors.lastname: Brunetti
authors.affiliation: Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.affiliation: Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France.
authors.forename: Nicola
authors.initials: N
authors.lastname: de'Angelis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011182:Postoperative Care; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Laparoscopic total mesorectal excision; Locally advanced rectal cancer; Neoadjuvant chemoradiation therapy; Surgical morbidity; Tumor regression grading