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Updated: Aug 3, 2025
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Word of caution: Rectal cancer without response to neoadjuvant treatment - Do not wait for surgery
Leonardo C Duraes1, Matthew F Kalady2, David Liska1
1Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Background:
We hypothesized that prolonging the interval to surgery in non-responders to neoadjuvant chemoradiation therapy (nCRT) could lead to worse oncologic outcomes.
Methods:
Rectal adenocarcinoma patients with poor tumor response to nCRT (AJCC tumor regression grade 3) were selected. Oncologic outcomes were evaluated according to the time interval between completion of nCRT and surgery.
Results:
Among 56 non-responders, 28 patients surgically treated ≥8 weeks after completion of nCRT had worse disease-free survival (31% vs. 49%, p = 0.05) and worse overall survival (34% vs. 53%, p = 0.02) compared to patients <8 weeks. Using the three different intervals (≥12 weeks, 6-12 weeks, and< 6 weeks), waiting longer was consistently associated with worse overall (23% vs. 48% vs. 63%, p = 0.02) and worse cancer-specific survival (35% vs. 61% vs. 71%, p = 0.04), respectively.
Conclusion:
For rectal cancer patients who are non-responders to nCRT, delay of surgery may lead to worse oncologic outcomes.
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