Background

Neoadjuvant chemoradiotherapy (nCRT) is the standard of care in locally advanced rectal cancer (LARC). However, radiation therapy is thought to increase operative difficulty due to induction of fibrosis. Total neoadjuvant therapy (TNT) protocols increase the time between completion of radiation and surgical resection which may lead to increased operative difficulty and complications.

Methods

A single institution retrospective review of patients ≥18 years with LARC undergoing nCRT from 2015 to 2022. Patients were dichotomized in 2 cohorts: <90 days from radiation to surgery (recent radiation), and ≥90 days from radiation to surgery (distant radiation). Institutional data was compared to National Surgical Quality Improvement Program (NSQIP) rectal cancer data from 2016 to 2020. Outcomes included intraoperative complications, 30-day morbidity, and oncologic outcomes.

Results

One hundred forty-six institutional patients included, 120 had recent radiation, 26 had distant radiation. Thirty-day morbidity and intraoperative complications did not differ. There was greater radial margin positivity (7% vs. 24%), fewer lymph nodes harvested (17 ± 5 vs. 15 ± 6), and a lower rate of complete mesorectal dissection (88% vs. 65%,) in distant radiation patients 3059 patients were included in NSQIP analysis, 2029 completed radiation <90 days before surgery and 1030 without radiation 90 days before surgery. Patients without radiation 90 days preoperatively had more radial margin positivity (9.2% vs. 4.6%), organ space infection (8.6% vs. 6.4%), and pneumonia (2.2% vs. 0.9%).

Conclusion

The present study suggests that increased time between radiation and surgery results in more challenging dissection with less complete mesorectal dissection and increased radial margin positivity without increasing technical complications.

中文翻译：

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直肠癌近期和远期新辅助放射治疗的结果：NSQIP 的机构回顾性审查和分析

背景

新辅助放化疗(nCRT) 是局部晚期直肠癌 (LARC) 的标准治疗方法。然而，放射治疗被认为会由于诱导纤维化而增加手术难度。完全新辅助治疗（TNT）方案增加了完成放疗和手术切除之间的时间，这可能导致手术难度和并发症增加。

方法

对 2015 年至 2022 年接受 nCRT 的 ≥18 岁 LARC 患者进行单一机构回顾性审查。患者被分为 2 个队列：从放疗到手术 < 90 天（近期放疗）和从放疗到手术 ≥ 90 天（远距离放疗） 。将机构数据与 2016 年至 2020 年国家手术质量改进计划 (NSQIP) 直肠癌数据进行比较。结果包括术中并发症、30 天发病率和肿瘤学结果。

结果

包括 146 名机构患者，其中 120 名接受过近期放射治疗，26 名接受过远距离放射治疗。三十天的发病率和术中并发症没有差异。远距离放射中，径向切缘阳性率更高（7% vs. 24%），收获的淋巴结更少（17 ± 5 vs. 15 ± 6），并且直肠系膜完全切除率较低（88% vs. 65%）。 NSQIP 分析中纳入了 3059 名患者，其中 2029 名患者在手术前 90 天以内完成了放射治疗，1030 名患者在手术前 90 天没有接受放射治疗。术前 90 天未接受放射治疗的患者桡骨切缘阳性率较高（9.2% vs. 4.6%），器官间隙感染（8.6% vs. 6.4%）和肺炎（2.2% vs. 0.9%）较多。

结论

本研究表明，放疗和手术之间的时间增加会导致更具挑战性的解剖，直肠系膜解剖不完全，并且在不增加技术并发症的情况下增加径向切缘阳性率。