Pathologic complete response is associated with decreased morbidity following rectal cancer resection
| Autor: | Ya Ching Hung, Christopher R. D'Adamo, Shane Svoboda, Blessing O Aghedo, Joshua H. Wolf, Arun Mavanur, Solange Cox |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Databases Factual Colorectal cancer Logistic regression Postoperative Complications Internal medicine Humans Medicine Stage (cooking) Aged Retrospective Studies Proctectomy Rectal Neoplasms business.industry Confounding Retrospective cohort study General Medicine Middle Aged medicine.disease Quality Improvement Exact test Logistic Models T-stage Female Surgery business Body mass index |
| Zdroj: | The American Journal of Surgery. 222:390-394 |
| ISSN: | 0002-9610 |
| Popis: | Background There are conflicting data regarding the relationship between pathologic complete response (pCR) and post-operative complications following rectal cancer resection. The objective of this study was to compare the rates of morbidity among pCR patients and non-pCR patients and to identify factors that predict pCR morbidity in a large national database. Methods This is a retrospective study using American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) targeted proctectomy data (2016–18). Patients with neoadjuvant chemoradiation therapy followed by proctectomy were included, and divided into pCR and non-pCR groups according to final stage. The groups were compared with Student’s t-test, Chi-squared or Fisher’s exact test. Multivariate logistic regression models were constructed to estimate the association between pCR status and post-operative morbidity while adjusting for key covariates. Results 244 pCR and 1656 non-pCR patients were included. pCR patients had higher body mass index (28.1 ± 6.2 vs. 29.1 ± 5.9 kg/m2; p = 0.01) and lower pre-operative stage (T stage, p = 0.03; N stage, p 0.05). Post-operative complications in pCR patients were less frequent than in non-pCR patients (23.0% vs. 29.3%; p = 0.04). This association was robust to adjustment for confounders in logistic regression, as patients with pCR had decreased odds of post-operative morbidity (OR 0.66, CI [0.43, 0.96], p = 0.04). Conclusion pCR is associated with fewer post-operative complications compared to non-pCR, suggesting that pCR is not a marker of severe pelvic fibrosis. This difference may be due to underlying tumor biology, and associated increased technical challenges resecting larger, non-responsive tumors. |
| Databáze: | OpenAIRE |
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