title: Clinical implications of preoperative chemoradiotherapy prior to laparoscopic surgery for locally advanced low rectal cancer.
abstract: The present study aimed to evaluate whether preoperative chemoradiotherapy (CRT) has any adverse effects on laparoscopic surgery (LS) for locally advanced low rectal cancer (LARC). The study was performed at the Osaka Medical College Hospital, and included patients who were operated on between July 2006 and December 2013. The short-term outcomes in 156 patients who underwent surgery for LARC following CRT were evaluated, of whom 152 underwent LS. Among the patients who were followed for >40 months, 77 patients (the CRT group) were compared with 39 patients who underwent LS without CRT (the surgery-alone group) for long-term outcomes. The total number of patients who received sphincter-preserving surgery was 74%. No positive longitudinal resection margins were identified, and only 1.3% had identifiable positive circumferential resection margins. The complication rate was 14%, and no serious complications occurred. There were no significant differences between the CRT and the surgery-alone groups in terms of the 5-year relapse-free survival rate (70.1 vs. 61.5%; P=0.81) or the 5-year overall survival rate (88.3 vs. 69.2%; P=0.06). However, the 5-year local recurrence-free survival rate was significantly improved in the CRT group patients (96.1 vs. 79.5%; P=0.009). In conclusion, our results have demonstrated that LS with preoperative CRT appears to be feasible and safe, and may have beneficial effects on local recurrence.
authors.affiliation: Department of Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan.
authors.forename: Keisaku
authors.initials: K
authors.lastname: Kondo
authors.affiliation: Department of Radiology, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan.
authors.forename: Taiju
authors.initials: T
authors.lastname: Shimbo
authors.affiliation: Department of Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Radiology, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Narumi
authors.affiliation: Department of Surgery, Osaka Medical College Hospital Cancer Center, Takatsuki, Osaka 569-8686, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Okuda
authors.affiliation: Department of Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka 569-8686, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
keywords: laparoscopic surgery; long-term outcome; low rectal cancer; preoperative chemoradiotherapy; short-term outcome