Abstracts
2002 Digestive Disease Week

# 101354 Abstract ID: 101354 The Role of Repeat Computed Tomography Scan for Locally Advanced Rectal Cancers Following Neoadjuvant Chemoradiation Therapy
Richard Smith, Jeffrey Kavolius, Matthew Mayfield, Matthew Chung, Edmund Burke, TAMC, HI; Honolulu, HI

Purpose: Neoadjuvant therapy (NAT) has become increasingly utilized in locally advanced rectal cancer. Complete staging of both the primary tumor and intraabdominal metastases is feasible with computed tomography (CT) of the abdomen and pelvis. Although restaging of rectal cancer with endorectal ultrasound following NAT has been reported, the role of repeat CT scan in this setting remains unclear. Methods: A retrospective study of all patients with resectable locally advanced rectal cancer (clinical T3 or higher) undergoing resection following NAT between September 1996 and December 2001. Clinical stage was determined by digital rectal exam and baseline CT scan. A subset of these patients had repeat CT scan prior to surgery based on individual surgeon practice. Patients who were restaged with CT scan prior to resection were compared to those who were not. Rates of local and distant progression of disease following NAT were compared between the two groups. Results: A total of 32 patients met the inclusion criteria: 13 were restaged (RS) and 19 were not (NRS). Demographics of patients as well as the initial CT staging were similar in both groups. At the time of surgery, local progression of disease was identified in 0/13 RS patients and 1/19 NRS patients (P>0.99). Distant progression of disease (liver metastasis) was found in 1/13 RS patients and 3/19 NRS patients (P=0.63). The liver metastasis seen on restaging CT scan was identified at the time of surgery and would have been identified regardless of CT findings. The primary tumor was resected in all patients in both groups. The preoperative and operative notes were reviewed and there were no changes to the operative plan as a result of restaging CT scans. Conclusions: In patients with locally advanced rectal cancer surgical management is not altered by findings on restaging CT scans. This questions the utility of this practice from a clinical as well as cost based aspect.