Does complete pathological response increase perioperative morbidity risk in rectal cancer?

Area of Science:

• Oncology
• Surgical Gastroenterology
• Clinical Research

Background:

• Optimal management of rectal cancer post-neoadjuvant treatment remains debated.
• Clinical complete response after neoadjuvant therapy for rectal cancer is a key prognostic indicator.

Purpose of the Study:

• To compare surgical morbidity in patients with locally advanced rectal cancer.
• To determine if pathological complete response (pCR) impacts complication rates after neoadjuvant chemoradiotherapy (NCRT) and total mesorectal excision (TME).

Main Methods:

• Retrospective cohort study using the Binational Colorectal Cancer Audit database (Australia and New Zealand).
• Included patients with locally advanced rectal cancer undergoing NCRT and surgical resection between 2007-2019.
• Compared complication rates between patients with and without pCR.

Main Results:

• 4584 patients analyzed; 11% achieved pCR.
• Total mesorectal excision (TME) with anastomosis had lower major/minor complications than TME without anastomosis.
• In TME with anastomosis, pCR did not increase complications; male gender, age, N stage, and ASA score ≥3 were significant factors.
• pCR did not affect anastomotic leak rates; male gender and interval to surgery did.

Conclusions:

• Pathological complete response (pCR) does not elevate surgical complication rates in rectal cancer patients.
• Factors like male gender, age, preoperative N stage, and ASA score influence complications in TME with anastomosis.
• This study clarifies the safety of TME dissection irrespective of pCR status post-NCRT.