Limited surgery following neoadjuvant treatment among patients with localized rectal cancer; a population-based study

Abstract

ABSTRACT Objective To evaluate the characteristics and outcomes of patients with localized rectal cancer treated with limited versus radical surgery following neoadjuvant treatment. Methods Surveillance, Epidemiology, and End Results (SEER) database has been accessed and patients with localized rectal adenocarcinoma (M0) 2004–2015 who have received neoadjuvant radiation before having some sort of surgery were included. Multivariable Cox regression analysis was then used to assess the impact of the type of resection on overall survival and cancer-specific survival. Results A total of 19162 individuals who have undergone radical surgery and 450 individuals who have undergone limited surgery were included. Using multivariable logistic regression analysis, the following factors were associated with a higher likelihood of radical surgery: younger age (OR for age ≥65 years versus 17–64 years: 0.430; 95% CI: 0.355-0.520) and clinically node-positive stage (OR: 2.442; 95% CI: 1.858-3.211). Within multivariable Cox regression analysis, limited surgery was associated with worse overall survival (HR: 1.276; 95% CI: 1.092-1.491) but no difference in cancer-specific survival (HR: 0.980; 95% CI: 0.728-1.318). Conclusion Among patients with localized rectal cancer treated with neoadjuvant radiation, there does not seem to be a difference in cancer-specific survival according to the type of surgery (limited versus radical surgery).