Abstract
Aims. To compare the surgical and oncological outcomes of rectal mucinous adenocarcinomas treated with neoadjuvant chemoradiotherapy versus surgery alone. Methods. A total of 167 locally advanced rectal mucinous adenocarcinoma patients treated with neoadjuvant chemoradiotherapy and surgery alone between 2008 and 2014 were matched using propensity score; the surgical and oncological outcomes were compared. Results. Ninety-six patients were matched. Postoperative morbidity was similar between groups. Sphincter preservation rate was higher in patients receiving neoadjuvant chemoradiotherapy (79.2% versus 60.4%, P = 0.045), especially for tumors ≥ 3 cm but ≤5 cm from the anal verge (75.0% versus 44.0%, P = 0.036). With a median follow-up of 54.8 months, the 5-year overall survival rate (neoadjuvant chemoradiotherapy versus surgery alone: 79.6% versus 67.1%; P = 0.599) and disease-free survival rate (75.6% versus 64.2%; P = 0.888) were similar. The 5-year local recurrence rate was lower in patients receiving neoadjuvant chemoradiotherapy (7.7% versus 26.0%, P = 0.036), while no difference was observed in distant metastasis. A poor response to chemoradiation was associated with higher local recurrence (P = 0.037). Conclusions. Compared with surgery alone, neoadjuvant chemoradiotherapy was found to increase the sphincter preservation rate and reduce local recurrence, thus being beneficial for locally advanced rectal mucinous adenocarcinoma patients.
Highlights
Neoadjuvant chemoradiotherapy followed by curative resection is considered as a standard of care for locally advanced low rectal cancer (LARC)
After using 1 : 1 propensity score matching, 48 patients treated with Neoadjuvant chemoradiotherapy (nCRT) and 48 patients treated with surgery alone were matched in our final analysis
A total of 79.2% of patients in the nCRT group underwent low anterior resection (LAR) compared to 60.4% in the surgery-alone group (P = 0.009), while abdominoperineal resection (APR) was performed less often in the nCRT group (12.5% versus 37.5%)
Summary
Neoadjuvant chemoradiotherapy (nCRT) followed by curative resection is considered as a standard of care for locally advanced low rectal cancer (LARC). This multimodal treatment has the potential to induce tumor downsizing and tumor downstaging and possibly improve sphincter preservation and local control [1,2,3]. Other studies have shown no difference in survival outcomes between the two histological subtypes [9, 13]. Those data were derived from comparisons between rectal MAC and non-MAC treated with nCRT based on nonmatched cohorts. No case-matched study has compared the long-term outcomes of rectal MAC treated with nCRT and surgery alone
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