Post-Operative Morbidity and Mortality Following Total Neoadjuvant Therapy Versus Conventional Neoadjuvant Chemoradiothe
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ORIGINAL RESEARCH
Post-Operative Morbidity and Mortality Following Total Neoadjuvant Therapy Versus Conventional Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer Philip Sutera 1 & Julia Solomina 2 & Rodney E. Wegner 3 & Stephen Abel 3 & Dulabh Monga 4 & Gene Finley 4 & James McCormick 2 & Alexander V. Kirichenko 3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Standard of care for locally advanced rectal cancer (LARC) (stage II/III) includes preoperative chemoradiation (CRT) followed by resection and adjuvant chemotherapy. Total neoadjuvant therapy (TNT) is a new treatment paradigm that delivers systemic therapy prior to CRT aimed at improving outcomes for high-risk patients. Here we analyzed the national cancer database (NCDB) comparing short-term post-operative outcomes between patients receiving TNT and CRT. Methods The NCDB was queried to identify patients with LARC between the 2004 and 2014 treated with TNT or CRT. Primary outcomes included post-operative 30-day mortality and readmissions between TNT and CRT which were analyzed via logistic regression. Secondary outcomes included post-operative length of stay (LOS) and OS which were compared with two-tailed ttest and Kaplan-Meier with log rank testing, respectively. Results A total of 9066 patients met inclusion criteria with a median age at diagnosis that was 57 years (IQR, 19–65); 62.3% were male and 87.8% white. Neoadjuvant therapy consisted of either standard CRT (97.2%) or TNT (2.8%). Patients treated at academic programs and those with N1 [p < 0.001, OR 2.34, 95%CI 1.71–3.19] or N2 [p < 0.001, OR 3.29, 95%CI 2.19–4.94] disease were associated with increased utilization of TNT. TNT was not significantly associated with either 30-day mortality (p = 1.0) or readmissions (p = 0.82). Further, there was no significant difference identified between CRT and TNT for hospital LOS or OS (p = 0.18). Conclusion This large-scale analysis of patients with LARC demonstrates increased utilization of TNT in patients harboring node-positive disease. Further, TNT does not appear to increase 30-day post-operative mortality, readmissions, or hospital LOS. Keywords Locally Advanced Rectal Cancer . Total Neoadjuvant Therapy . NCDB . Post-op Mortality
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12029-020-00401-3) contains supplementary material, which is available to authorized users. * Rodney E. Wegner [email protected] 1
Department of Internal Medicine, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15212, USA
2
Division of Colorectal Surgery, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15212, USA
3
Division of Radiation Oncology, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15212, USA
4
Division of Medical Oncology, Allegheny Health Network, 320 East North Avenue, Pittsburgh, PA 15212, USA
Standard of care treatment for stage II/III locally advanced rectal cancer (LARC) includes preope
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