Total mesorectal excision with or without preoperative chemoradiotherapy for resectable mid/low rectal cancer: a long-term analysis of a prospective, single-center, randomized trial | Cancer Communications | Full Text

Total mesorectal excision with or without preoperative chemoradiotherapy for resectable mid/low rectal cancer: a long-term analysis of a prospective, single-center, randomized trial | Cancer Communications | Full Text

Cancer Communications

Total mesorectal excision with or without preoperative chemoradiotherapy for resectable mid/low rectal cancer: a long-term analysis of a prospective, single-center, randomized trial

• Fulong Wang†,
• Wenhua Fan†,
• Jianhong Peng†View ORCID ID profile,
• Zhenhai Lu,
• Zhizhong Pan,
• Liren Li,
• Yuanhong Gao,
• Hui Li,
• Gong Chen,
• Xiaojun Wu,
• Peirong Ding,
• Zhifan Zeng and
• Desen WanEmail author

†Contributed equally

Cancer Communications201838:73

https://doi.org/10.1186/s40880-018-0342-8

©  The Author(s) 2018

• Received: 14 February 2018
• Accepted: 22 November 2018
• Published: 20 December 2018

Abstract

Background

The preliminary results of our phase II randomized trial reported comparable functional sphincter preservation rates and short-term survival outcomes between patients undergoing total mesorectal excision (TME) with or without preoperative concurrent chemoradiotherapy (CCRT). We now report the long-term results after a median follow-up of 71 months.

Methods

Between March 23, 2008 and August 2, 2012, 192 patients with T3-T4 or node-positive, resectable, mid/low rectal adenocarcinoma were randomly assigned to receive TME with or without preoperative CCRT. The following endpoints were assessed: cumulative rates of local recurrence and distant metastasis, disease-free survival (DFS), and overall survival (OS).

Results

The data of 184 eligible patients were analyzed: 94 patients in the TME group and 90 patients in the CCRT + TME group. In the whole cohort, the 5-year DFS and OS rates were 84.8% and 85.1%, respectively. The 5-year DFS rates were 85.2% in the CCRT + TME group and 84.3% in the TME group (P = 0.969), and the 5-year OS rates were 83.5% in the CCRT + TME group and 86.5% in the TME group (P = 0.719). The 5-year cumulative rates of local recurrence were 6.3% and 5.0% (P = 0.681), and the 5-year cumulative rates of distant metastasis were 15.0% and 15.7% (P = 0.881) in the CCRT + TME and TME groups, respectively. No significant improvements in 5-year DFS and OS were observed with CCRT by subgroup analyses.

Conclusions

Both treatment strategies yielded similar long-term outcomes. A selective policy towards preoperative CCRT is thus recommended for rectal cancer patients if high-quality TME surgery and enhanced chemotherapy can be performed.

Trial registration ChiCTR-TRC-08000122. Registered 16 July 2008

Keywords

• Rectal cancer
• Total mesorectal excision
• Chemoradiotherapy
• Long-term outcomes
• Phase II randomized trial