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The Association between Pathologic Complete Response after Neoadjuvant Chemoradiotherapy and Postoperative
Shawn Hsu1, Katherine J Rosen1, Larissa Temple1
1Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, New York, USA.
Digestive Surgery
|June 1, 2021
Summary
Achieving pathologic complete response (pCR) after rectal cancer treatment is not linked to increased postoperative complications. Patients with pCR actually show a reduced risk of sepsis, a positive finding for rectal cancer surgery outcomes.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Clinical Research
Background:
- The watch-and-wait strategy for rectal cancer is gaining traction, necessitating a clear understanding of its risks and benefits.
- While avoiding surgery is desirable, the potential for recurrence and the need for salvage surgery must be considered.
- The link between achieving a pathologic complete response (pCR) and subsequent postoperative complications remains unclear.
Purpose of the Study:
- To investigate the association between pathologic complete response (pCR) and postoperative complications in rectal cancer patients.
- To evaluate the impact of pCR on major complications, sepsis, anastomotic leak, organ space infection, return to operating room, and septic shock.
Main Methods:
- A retrospective analysis of 3,878 rectal cancer patients from the National Surgical Quality Improvement Program (NSQIP) databases (2016-2018).
- Patients included received neoadjuvant therapy within 90 days of surgery.
- Statistical analysis was performed to assess the relationship between pCR and various postoperative outcomes, including risk adjustment.
Main Results:
- The overall pCR rate was 12.8%.
- No significant association was found between pCR and major complications, anastomotic leak, organ space infection, or return to the operating room.
- Patients achieving pCR had significantly lower odds of developing postoperative sepsis (adjusted OR = 0.42, p = 0.03).
Conclusions:
- Achieving pCR in rectal cancer patients is not associated with an increased risk of major postoperative complications.
- A pathologic complete response (pCR) is associated with a reduced likelihood of postoperative sepsis following rectal surgery.
- These findings are reassuring for the watch-and-wait strategy and suggest better outcomes for patients with pCR.
