Postoperative radio-chemotherapy for rectal cancer: a retrospective analysis from a tertiary referral hospital

Abstract Background Total mesorectal excision (TME) is an essential treatment method in rectal cancer (RC). Perioperative radiotherapy in locally advanced RC improves loco-regional free survival (LRFS). Preoperative radiotherapy is a preferred option; however, some patients are not referred for it. In case of the risk of loco-regional failure, postoperative radio-chemotherapy (RT-CHT) is indicated. We report results of such an approach. Material and methods Between 2004 and 2010, 182 patients with pathological stage II-III RC (TME performed - 41%, resection R0 – 88%, circumferential resection margin evaluated – 55.5% and was above 2 mm in 66% of them) received postoperative RT-CHT in our institution. Overall survival (OS) and LRFS were estimated with the Kaplan-Meier method. Univariate and multivariate analysis were performed to compare the impact of prognostic factors on survival. Results Five-year OS and LRFS rates were 63% and 85%, respectively. Loco-regional recurrence and isolated distant metastases rates were 11.5% and 19%, respectively. Multivariate analysis showed stage (III vs. II), HR:2.3 (95% confidence interval [CI]:1.4-3.8), p = 0.0001; extent of resection (R1-2 vs. R0), HR:2.14 (95%CI:1.14-3.99), p = 0.017, and age (>65 vs. ≤ 65 years), HR:1.66 (95%CI:1.06-2.61), p = 0.027 as prognostic factors for OS. Extent of resection (R1-2 vs. R0), HR:3.65 (95%CI:1.41-9.43), p = 0.008 had significant impact on LRFS. Conclusion Despite a suboptimal quality of surgery and pathological reports, the outcome in our series is close to that reported in the literature. We confirm a strong impact of the extent of resection on patient’s outcome, which confirms the pivotal role of surgery in the management of RC.