Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 16;21(1):247.
doi: 10.1186/s12957-023-03136-0.

Postoperative recurrence in locally advanced rectal cancer: how does neoadjuvant treatment affect recurrence pattern?

Ryosuke Okamura  1 , Yoshiro Itatani  2 , Yusuke Fujita  1 , Nobuaki Hoshino  1 , Shintaro Okumura  1 , Kazuhiro Nishiyama  1 , Koya Hida  1 , Kazutaka Obama  1
Affiliations

Postoperative recurrence in locally advanced rectal cancer: how does neoadjuvant treatment affect recurrence pattern?

Ryosuke Okamura et al. World J Surg Oncol. .

Abstract

Background: The treatment strategy for locally advanced rectal cancer (LARC) has recently expanded from total mesorectal excision to additional neoadjuvant chemoradiotherapy (nCRT) and/or systemic chemotherapy (NAC). Data on disease recurrence after each treatment strategy are limited.

Methods: Clinical stage II to III rectal cancer patients who underwent curative surgery between July 2005 and February 2021 were analyzed. The cumulative incidence and site of first recurrence were assessed. The median follow-up duration was 4.6 years.

Results: Among the 332 patients, we performed nCRT and NAC in 15.4% (N=51) and 14.8% (N=49), respectively. The overall recurrence rate was 23.5% (N=78). Although several differences in tumor stage or location were observed, there was no significant difference in the rate among the surgery alone (N=54, 23.3%), nCRT (N=11, 21.6%), and NAC (N=13, 26.5%) groups. In this cohort, the local recurrence rate (18.4%) was higher than the rate of distant metastasis in the NAC group (14.3%). All patients with recurrence in the nCRT group had distant metastases (N=11: one patient had distant and local recurrences simultaneously). For pathological stage 0-I, the recurrence rate was higher in the nCRT and NAC groups than in the surgery-alone group (nCRT, 10.0%; NAC, 15.4%; and surgery-alone, 2.0%). Curative-intent resection of distant-only recurrences significantly improved patients' overall survival (hazard ratio [95% confidence interval], 0.34 [0.14-0.84]), which was consistent even when stratified according to neoadjuvant treatment. Regardless of neoadjuvant treatment, >80% of recurrences occurred in the first 2.2 years, and 98.7% within 5 years after surgery.

Conclusion: Regardless of neoadjuvant treatment, detecting distant metastases with intensive surveillance, particularly in the first 2 years after surgery, is important. Also, even if neoadjuvant treatment can downstage LARC to pathological stage 0-I, careful follow-up is needed.

Keywords: Metastasectomy; Neoadjuvant; Rectal cancer; Recurrence.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Overall survival after primary surgery according to treatment for recurrence. A In patients with distant-only recurrence (N=48). B In patients with local-only recurrence (N=19)
Fig. 2
Fig. 2
Cumulative incidence of disease recurrence after surgery for LARC. A Overall patients with recurrence (N=78). B According to neoadjuvant treatments (surgery alone [N=54], nCRT [N=11], and NAC [N=13]). C According to pathological stages (0-I [N=5], II [N=29], and III [N=44]). D According to recurrence sites (lung [N=32], local [N=30], liver [N=18], and others [N=17]). Multiple sites were allowed
See this image and copyright information in PMC

References

    1. Fokas E, Schlenska-Lange A, Polat B, Klautke G, Grabenbauer GG, Fietkau R, Kuhnt T, Staib L, Brunner T, Grosu AL, et al. Chemoradiotherapy plus induction or consolidation chemotherapy as total neoadjuvant therapy for patients with locally advanced rectal cancer: long-term results of the CAO/ARO/AIO-12 randomized clinical trial. JAMA Oncol. 2022;8:e215445. doi: 10.1001/jamaoncol.2021.5445. - DOI - PMC - PubMed
    1. Cerdán-Santacruz C, Vailati BB, São Julião GP, Habr-Gama A, Perez RO. Watch and wait: why, to whom and how. Surg Oncol. 2022;43:101774. doi: 10.1016/j.suronc.2022.101774. - DOI - PubMed
    1. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol. 2012;17:1–29. doi: 10.1007/s10147-011-0315-2. - DOI - PubMed
    1. Sargent D, Sobrero A, Grothey A, O'Connell MJ, Buyse M, Andre T, Zheng Y, Green E, Labianca R, O'Callaghan C, et al. Evidence for cure by adjuvant therapy in colon cancer: observations based on individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol. 2009;27:872–877. doi: 10.1200/JCO.2008.19.5362. - DOI - PMC - PubMed
    1. Meyerhardt JA, Mangu PB, Flynn PJ, Korde L, Loprinzi CL, Minsky BD, Petrelli NJ, Ryan K, Schrag DH, Wong SL, Benson AB., 3rd Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol. 2013;31:4465–4470. doi: 10.1200/JCO.2013.50.7442. - DOI - PubMed

LinkOut - more resources