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Factors associated with local recurrence after neoadjuvant chemoradiation with total mesorectal excision for rectal cancer.

 Nam-Kyu Kim  ;  Young-Wan Kim  ;  Byung-Soh Min  ;  Kang-Young Lee  ;  Seung-Kook Sohn  ;  Chang-Hwan Cho 
 WORLD JOURNAL OF SURGERY, Vol.33(8) : 1741-1749, 2009 
Journal Title
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Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Chemotherapy, Adjuvant ; Chi-Square Distribution ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local/pathology* ; Neoplasm Staging ; Postoperative Complications/epidemiology ; Proportional Hazards Models ; Radiotherapy, Adjuvant ; Rectal Neoplasms/drug therapy ; Rectal Neoplasms/pathology* ; Rectal Neoplasms/radiotherapy ; Rectal Neoplasms/surgery ; Risk Factors ; Survival Rate
BACKGROUND: The purpose of the present study was to investigate risk factors associated with local recurrence in patients with locally advanced rectal cancer who received preoperative chemoradiotherapy in combination with total mesorectal excision (TME). METHODS: Rectal cancer patients who were treated with neoadjuvant chemoradiation with TME were studied. We compared 26 patients who developed local recurrence with 119 recurrence-free patients during the follow-up period. RESULTS: The median follow-up period was 52 months (range: 14-131 months). Based on the use of univariate and multivariate analyses, circumferential margin involvement (p = 0.02), the presence of lymphovascular or perineural invasion (p = 0.02), and positive nodal disease (p = 0.03) were contributing factors for local recurrence. The local recurrence rate was different between ypN(+) patients and ypN(-) patients with more than 12 nodes retrieved (p = 0.01). There was no difference in local recurrence rates between ypN(+) patients and ypN(-) patients with < 12 nodes (p = 0.35) or between ypN(-) patients with < 12 nodes or > or = 12 nodes (p = 0.18). CONCLUSIONS: Patients with circumferential margin involvement, the presence of lymphovascular or perineural invasion, and positive nodal disease should be regarded as a high-risk group. We also determined that lymph node retrieval (< 12 nodes) in patients with node-negative disease was a risk factor for local recurrence.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Sohn, Seung Kook(손승국)
Lee, Kang Young(이강영)
Cho, Chang Hwan(조장환)
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