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NEOADJUVANT TREATMENT STRATEGY AND CORRELATION WITH FUNCTIONAL OUTCOMES AFTER LOW ANTERIOR RESECTION FOR RECTAL CANCER
Felipe F. Quezada*, Rosa M. Jimenez-Rodriguez, Emmanouil Pappou, Jesse Joshua Smith, Iris H. Wei, Jose Guillem, Philip Paty, Garrett Nash, Martin Weiser, Julio Garcia-Aguilar
Department of Surgery. Colorectal Service., Memorial Sloan Kettering Cancer Center, New York, NY
Introduction: The standard treatment of locally advanced rectal cancer (LARC) includes neoadjuvant chemoradiation (CRT), total mesorectal excision (TME) and adjuvant chemotherapy. Neoadjuvant chemotherapy (NAC) and total neoadjuvant therapy (TNT) are increasingly used as an alternative to CRT in patients with locally advanced rectal cancer. However the impact of these new neoadjuvant strategies on anorectal function remains largely unknown. We evaluate the effect of various neoadjuvant treatments (NAT) on bowel function in patients with LARC treated with TME and sphincter preservation (SP).
Methods: Retrospective review of rectal cancer patients with tumors located within 10 cm from the anal verge and treated with TME and SP between 2012 and 2017. Patients with stage IV disease were excluded. All patients had previously completed the MSKCC Bowel Function Instrument (MSKCC BFI) validated questionnaire. MSKCC BFI score < 53 was used as the cut-off for defining worse bowel function (25th percentile of the present cohort). Surveys were filed online at least 6 months from TME or ileostomy reversal (for patients with diverting stoma). Patients were stratified into four groups based on the NAT regimen received: no NAT, CRT, NAC, and TNT (neoadjuvant chemotherapy and neoadjuvant chemoradiation). Comparisons between groups were performed with chi-square test for categorical variables and non-parametric test for continuous variables. The association of clinically relevant variables and those significant in univariate analysis with outcomes of interest were established using logistic regression for primary endpoint.
Results: A total of 136 patients were included. Clinical and treatment variables, MSKCC BFI Total Score are summarized in Table 1. We found no differences in clinical or treatment variables between groups. In multivariate analysis, lower tumor height (OR 0.79, 95% CI 0.65-0.96) and the CRT group (OR 6.01, 95% CI 1.38 to 26.14) were associated with higher rate of MSKCC BFI total score <53.
Conclusion: These data suggest that compared to other neoadjuvant strategies, CRT is associated with worse bowel function as assessed by the BFI score. Further randomized prospective studies are needed to validate these findings.
Table 1
| Variable | No NAT (n=25)
| CRT (n=27)
| NAC (n=12)
| TNT (n=72)
| p value* | | Time from procedure to survey in months (median, range) | 13 (6 to 40)
| 15 (6 to 38)
| 13 (6 to 30)
| 12 (6 to 39)
| 0.44 | | Age, years (median, range) | 55 (30 to 75)
| 54 (34 to 78)
| 47.5 (26 to 77)
| 50 (26 to 72)
| 0.36 | | Tumor Height in cm (median, range) | 8 (4 to 10)
| 6.5 (4 to 9.5)
| 8 (4 to 10)
| 7 (1 to 10)
| 0.18 | | Gender, female (n,%) | 15 (60) | 10 (37) | 6 (50) | 31 (43.1) | 0.37 | | Robotic LAR (n, %) | 22 (88) | 20 (74.1) | 11 (91.7) | 60 (83.3) | 0.45 | | BMI>30 (n, %) | 5 (20) | 7 (25.9) | 2 (16.7) | 22 (30.6) | 0.63 | | Handsewn Anastomosis (n,%) | 2 (8) | 8 (29.6) | 1 (8.3) | 13 (18.1) | 0.17 | | Diverting loop ileostomy (n,%) | 21 (84) | 25 (92.6) | 10 (83.3) | 65 (90.3) | 0.68 | Complications, any (n,%)
Anastomotic Leaks (n,%)
| 11 (44)
3(12)
| 11 (40.7)
2 (7.4)
| 4 (33.3)
0
| 17 (23.6)
4 (5.6)
| 0.18
0.54
| | MSKCC BFI Total Score <53 (n,%) | 3 (12) | 13 (48.2) | 1 (8.3) | 19 (26.4) | 0.01 |
* Univariate analysis
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