Time interval between the completion of radiotherapy and robotic-assisted surgery among patients with stage I-III rectal cancer undergoing preoperative chemoradiotherapy.

Ching-Wen Huang,Tzu-Chieh Yin,Wei-Chih Su,Yi-Chien Hsieh,Hsiang-Lin Tsai,Tsung-Kun Chang,Po-Jung Chen,Ching-Chun Li,Yen-Cheng Chen,Jaw-Yuan Wang,Jason Chia-Hsun Hsieh

doi:10.1371/journal.pone.0240742

Abstract

BackgroundThis aim of this study was to evaluate the effects of time interval between the completion of radiotherapy and robotic-assisted surgery on the outcomes among patients with rectal cancer undergoing preoperative concurrent chemoradiotherapy (CCRT).MethodsIn total, 116 patients with stage I–III rectal cancer who underwent preoperative CCRT and robotic-assisted surgery between September 2013 and February 2019 were enrolled. Patients were categorized into two groups based on the time interval: group A (10–12 weeks) and group B (≥ 12 weeks).ResultsAmong the 116 enrolled patients, 98 (84.5%) had middle and lower rectal cancers. Two (1.7%) patients underwent abdominoperineal resection with a sphincter preservation rate of 98.3%. Thirty-seven (31.9%) patients had a pathologic complete response (pCR). The circumferential resection margin and distal resection margin were positive in 2 (1.7%) and 1 (0.9%) patients, respectively. Therefore, the R0 resection rate was 97.4%. A total of 24 (22.4%) patients experienced postoperative relapse and 12 (10.3%) patients died; these were slightly more common in group B than in group A (28.8% vs 15.8% and 15.3% vs 5.3%, respectively; both P > 0.05); however, this difference was nonsignificant. Three-year disease-free survival (DFS) and overall survival (OS) were 75% and 89%, respectively, among all patients. Non-significant trend of favorable 3-year DFS, 3-year OS, 3-year locoregional control rate and 3-year distant metastasis control rate were observed in group A compared with group B (all P > 0.05).ConclusionRobotic-assisted surgery after a longer interval is safe and feasible for patients with rectal cancer undergoing preoperative CCRT. The present study’s results suggested that the time interval of 10–12 weeks can be considered because comparable clinical and perioperative outcomes and preferable oncological outcomes were observed for interval of this length. However, future prospective randomized clinical trials are required to verify the present finding.

Highlights

In the past three decades, the treatment outcomes of rectal cancers have been substantially improved through novel therapeutic modalities and improved surgical approaches
The inclusion criteria were as follows: histologically proven rectal adenocarcinoma with tumor located within 15 cm from the anal verge, clinical stage I–III, preoperative concurrent chemoradiotherapy (CCRT) with FLOFX regimen and long-course radiotherapy (LCRT), robotic-assisted surgery, and interval between the completion of radiotherapy and robotic-assisted surgery of 10-week
No significant differences were observed between the two groups in short-term oncological outcomes; the time interval of 10–12 weeks between the completion of radiotherapy and robotic-assisted surgery can be considered as a safe interval, because no clear benefits were observed beyond this interval

Summary

Introduction

In the past three decades, the treatment outcomes of rectal cancers have been substantially improved through novel therapeutic modalities and improved surgical approaches. The standard surgical approach for patients with rectal cancer has been total mesorectal excision (TME) surgery, as reported by Heald and Ryall [1] in 1982, because it remarkably improves the clinical outcomes of these patients. Tepper JE et al reported a high 5–year LR rate of 14% and poor 5-year overall survival (OS) of 64% among patients with locally advanced rectal cancer (LARC) undergoing curative surgery and postoperative concurrent chemoradiotherapy (CCRT) [3]. Preoperative CCRT has since been the recommended as a standard treatment for patients with LARC This aim of this study was to evaluate the effects of time interval between the completion of radiotherapy and robotic-assisted surgery on the outcomes among patients with rectal cancer undergoing preoperative concurrent chemoradiotherapy (CCRT)

Methods

Results

Discussion

Conclusion