Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2020; 26(31): 4624-4638
Published online Aug 21, 2020. doi: 10.3748/wjg.v26.i31.4624
Impact of interval between neoadjuvant chemoradiotherapy and surgery in rectal cancer patients
Shi-Wen Mei, Zheng Liu, Fang-Ze Wei, Jia-Nan Chen, Zhi-Jie Wang, Hai-Yu Shen, Juan Li, Fu-Qiang Zhao, Wei Pei, Zheng Wang, Xi-Shan Wang, Qian Liu
Shi-Wen Mei, Zheng Liu, Fang-Ze Wei, Jia-Nan Chen, Zhi-Jie Wang, Hai-Yu Shen, Juan Li, Fu-Qiang Zhao, Wei Pei, Zheng Wang, Xi-Shan Wang, Qian Liu, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Mei SW, Chen JN, and Wang ZJ designed the research; Wei FZ, Shen HY, Li J, and Zhao FQ collected the data; Pei W, Wang Z, Liu Z, and Wei FZ analyzed the data; Mei SW drafted the manuscript; Liu Q and Wang XS revised the paper.
Supported by the National Key Research and Development Plan "Research on Prevention and Control of Major Chronic Non-Communicable Diseases", No. 2019YFC1315705; and the Medicine and Health Technology Innovation Project of Chinese Academy of Medical Sciences, No. 2017-12M-1-006.
Institutional review board statement: Our investigation received approval from the ethics committee of the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest in regard to this research.
Data sharing statement: No additional data are available.
STROBE statement: The authors have carefully read the STROBE statement checklist of items and prepared the manuscript based on the requirements of the STROBE statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Qian Liu, MD, Chief Doctor, Professor, Surgeon, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. fcwpumch@163.com
Received: May 26, 2020
Peer-review started: May 26, 2020
First decision: June 4, 2020
Revised: June 7, 2020
Accepted: August 1, 2020
Article in press: August 1, 2020
Published online: August 21, 2020
ARTICLE HIGHLIGHTS
Research background

Surgery with total mesorectal excision following neoadjuvant therapy is a standard regime for locally advanced rectal cancer. The optimal interval time between neoadjuvant therapy and surgery is still under debate.

Research motivation

There is a lack of consensus concerning the interval time between neoadjuvant therapy and surgery. Whether shorter or longer interval time is a controversial topic. And there are limited data regarding outcomes associated with different neoadjuvant therapy-surgery times.

Research objectives

The main aim of this study was to investigate whether different interval times affect the rate of pathologic complete response (pCR), preoperative outcomes, and survival status.

Research methods

We performed a retrospective cohort study and enrolled locally advanced rectal cancer patients with neoadjuvant therapy. Information regarding the clinicopathological features, clinical outcomes, and follow-up was collected and analyzed. Multivariate logistic regression analysis was performed to evaluate the possible factor affected by interval time.

Research results

The interval time between neoadjuvant therapy and surgery > 9 wk increased the incidence of pCR and had a better impact on disease-free survival (DFS).

Research conclusions

Prolonging the interval time between neoadjuvant therapy and surgery may be associated with improved rates of pCR, decreased disease recurrence, and improved DFS but has little impact on postoperative complications and sphincter preservation.

Research perspectives

Prospective randomized trials are required to evaluate the optimal time interval that is needed to achieve minimum morbidity, maximal tumor downstaging, and minimum disease recurrence.