Short-term Results and Long-term Oncologic Outcomes between Neoadjuvant Chemoradiotherapy and Adjuvant Postoperative Chemoradiotherapy for Stage III Rectal Cancer: A Case-matched Study

Abstract

To compare the short-term perioperative results and long-term oncologic outcomes between patients who underwent neoadjuvant chemoradiotherapy (NCRT) and patients who underwent postoperative adjuvant chemoradiotherapy (ACRT) for stage III rectal cancer. From January 1997 to December 2008, a total of 47 patients who were diagnosed as clinical stage III rectal cancer followed by NCRT were matched according to age, gender, and operation method to 47 patients with pathologic stage III rectal cancer who underwent ACRT. Clinical characteristics, surgical and pathologic outcomes, postoperative complications and recovery, and oncologic outcomes were compared between the two groups. There were no significant differences in demographics or preoperative characteristics between the NCRT and ACRT groups. Though more protective ileostomies were performed in the NCRT group, there was no statistical difference in operation times between the two groups. Patients in the NCRT group had a smaller tumor size (P < 0.001) and a smaller number of lymph nodes retrieved (P < 0.001). No differences were observed with respect to morbidity and recovery outcomes between the two groups. During the median 58-month follow-up periods, the NCRT group showed better disease-free survival and overall survival than the ACRT group (P = 0.002, P = 0.001, respectively). NCRT in comparison to ACRT did not increase the risk of postoperative morbidity and provided better disease-free and overall survival in stage III rectal cancer patients.