Upper Rectal Cancer: To Irradiate or Not?

Area of Science:

• Oncology
• Surgical Gastroenterology
• Radiation Oncology

Background:

• Neoadjuvant chemoradiotherapy (NCRT) is standard for mid and low rectal cancers.
• Its role in upper rectal cancer (11-15 cm from anal verge) is debated.
• Evaluating NCRT's impact on upper rectal cancer outcomes is crucial.

Purpose of the Study:

• To assess the safety and oncologic outcomes of NCRT followed by surgery versus surgery alone for upper rectal cancer.
• To compare postoperative complications, mortality, recurrence rates, and functional outcomes.

Main Methods:

• Retrospective cohort study of 31 locally advanced upper rectal cancer patients (2013-2022).
• Patients divided into NCRT group (n=18) and surgery-first group (n=13).
• Primary outcome: postoperative complications; Secondary: mortality, recurrence, Low Anterior Resection Syndrome (LARS).

Main Results:

• No significant difference in mortality or local recurrence between groups.
• NCRT group had a higher incidence of postoperative complications (66.7% vs. 38.5%).
• Significantly higher LARS rates in the NCRT group (27.8% vs. 0%).

Conclusions:

• NCRT for upper rectal cancer does not significantly improve local control compared to surgery alone.
• NCRT is associated with increased postoperative complications and LARS.
• Further research is needed to optimize treatment for upper rectal cancer, balancing efficacy and quality of life.