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International Journal of Colorectal Disease

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05-05-2022 | Rectal Cancer | Original Article

Involvement of tissue changes induced by neoadjuvant treatment in total mesorectal excision (TME): novel suggestions for determining TME quality

Authors: Jin Cheon Kim, Seong Ho Park, Jihun Kim, Chan Wook Kim, In Ja Park, Yong Sik Yoon, Jong Lyul Lee, Jong Hoon Kim, Yong Sang Hong, Tae Won Kim

Published in: International Journal of Colorectal Disease | Issue 6/2022

Abstract

Background

Few studies to date have investigated morphological changes after neoadjuvant treatment (NAT) and their implications in total mesorectal excision (TME). This study was primarily designed to evaluate whether tissue changes associated with NAT affected the quality of TME and additionally to suggest a more objective method evaluating TME quality.

Methods

This study enrolled 1322 consecutive patients who underwent curative robot-assisted surgery for rectal cancer. Patients who did and did not receive NAT were subjected to propensity-score matching, yielding 402 patients in each group.

Results

NAT independently reduced complete achievement of TME [odds ratio (OR) = 2.056, p = 0.017]. Intraoperative evaluation identified seven tissue changes significantly associated with NAT, including tumor perforation, mucin pool, necrosis, fibrosis, fat degeneration, and rectal or perirectal edema NAT (p < 0.001–0.05). Tumor perforation (OR = 5.299, p = 0.001) and mucin pool (OR = 14.053, p = 0.002) were independently associated with inappropriate (near-complete + incomplete) TME. Complete TME resulted in significantly reduced local recurrence (4.3% vs 15.3%, p = 0.003) and increased 5-year DFS rate (80.6% vs 67.6%, p = 0.047) compared with inappropriate one. By contrast, two tiers of complete and near-complete TMEs vs incomplete TME did not. Notably, among patients with complete TME, those who received NAT had a lower 5-year DFS than those who did not (77.8% vs 83.3%, p = 0.048).

Conclusions

NAT-associated tissue changes, somewhat interrupting complete TME, may provide unsolved clue to the relative inability of NAT to improve overall survival. The conventional three-tier grading of TME seems to be simplified into two tiers as complete and inappropriate.

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Title: Involvement of tissue changes induced by neoadjuvant treatment in total mesorectal excision (TME): novel suggestions for determining TME quality
Authors: Jin Cheon Kim
Seong Ho Park
Jihun Kim
Chan Wook Kim
In Ja Park
Yong Sik Yoon
Jong Lyul Lee
Jong Hoon Kim
Yong Sang Hong
Tae Won Kim
Publication date: 05-05-2022
Publisher: Springer Berlin Heidelberg
Keywords: Rectal Cancer
Rectal Cancer
Edema
Published in: International Journal of Colorectal Disease / Issue 6/2022
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-022-04165-z

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Springer Medicine

Involvement of tissue changes induced by neoadjuvant treatment in total mesorectal excision (TME): novel suggestions for determining TME quality

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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