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Open Access 19-07-2024 | Rectal Cancer | Original Article

Abdominoperineal Resection for T4 Low Rectal Cancer After Neoadjuvant Therapy—Are the Outcomes Acceptable?

Authors: Devesh S Ballal, Prudvi Raj, M Janesh, Mufaddal Kazi, Ashwin Desouza, Avanish P. Saklani

Published in: Indian Journal of Surgical Oncology | Issue 4/2024

Abstract

Introduction

There is no clear consensus on using the response MRI as opposed to the pretreatment MRI for surgical planning in cT4 low rectal cancer. The objective of this study is to determine the safety of using response MRI in surgical planning for T4 rectal cancer.

Methods

This study is a retrospective review of a prospectively maintained database of abdominoperineal resections conducted at a single tertiary cancer center. Patients undergoing an abdominoperineal resection were divided into 2 groups: group A (clinical T3, mesorectal fascia positive) and group B (clinical T4), and propensity matching was used to account for uneven distribution of baseline characteristics. Primary outcome was the rate of pathological circumferential resection margin positivity. Secondary outcomes were survival outcomes and recurrence patterns.

Results

There were 237 patients in group A and 127 in group B, in the unmatched cohort, with a significantly higher number of females (43.3% vs. 28.7%, p = 0.005) and anterior circumferential resection margin positivity (68.5% vs. 49%, p < 0.001), with a lower number of patients receiving neoadjuvant chemotherapy in group B (38.6% vs. 49.8%, p = 0.041). After propensity matching baseline characters were comparable. There was a higher percentage of extended-total mesorectal excisions in group B (58.5% vs. 40.5%, p = 0.004). The rate of pathological circumferential positivity was comparable in both groups (20/168 in group A {11.9%} vs. 13/107 in group B {12.1%}, p = 0.951) with no impact of group on circumferential resection margin positivity on univariate (OR 1.023, p = 0.951) or multivariate regression (OR 0.993, p = 0.987). Both the DFS (median DFS 39 months vs. 54 months, p = 0.970) and OS (3-year OS 72% vs. 67%, p = 0.798) were comparable between both groups.

Conclusion

For T4 low rectal cancers, post-treatment MRI can be used for surgical planning without any detriment in pathological or long-term oncological outcomes.

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Title: Abdominoperineal Resection for T4 Low Rectal Cancer After Neoadjuvant Therapy—Are the Outcomes Acceptable?
Authors: Devesh S Ballal
Prudvi Raj
M Janesh
Mufaddal Kazi
Ashwin Desouza
Avanish P. Saklani
Publication date: 19-07-2024
Publisher: Springer India
Keywords: Rectal Cancer
Rectal Cancer
Published in: Indian Journal of Surgical Oncology / Issue 4/2024
Print ISSN: 0975-7651
Electronic ISSN: 0976-6952
DOI: https://doi.org/10.1007/s13193-024-02028-3

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Abstract

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