Preoperative chemoradiotherapy versus surgery alone for advanced low rectal cancer: a large multicenter cohort study in
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ORIGINAL ARTICLE
Preoperative chemoradiotherapy versus surgery alone for advanced low rectal cancer: a large multicenter cohort study in Japan Tomonori Akagi1 · Masafumi Inomata1 · Hajime Fujishima1 · Meiki Fukuda2 · Tsuyoshi Konishi3 · Shunsuke Tsukamoto4 · Fuminori Teraishi5 · Heita Ozawa6 · Keitaro Tanaka7 · Koya Hida8 · Yoshiharu Sakai8 · Masahiko Watanabe9 Received: 26 February 2020 / Accepted: 17 May 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose To clarify the usefulness of chemoradiotherapy (CRT) for low rectal cancer, we investigated the current status of CRT in Japan and its short- and long-term outcomes versus surgery alone for low rectal cancer in a large multicenter cohort study. Methods Between January 2010 and December 2011, data from 1608 patients with clinical Stage II–III rectal adenocarcinoma were collected from 69 specialized centers. Of these 1608 patients, 923 were diagnosed with clinical stage III low rectal cancer, 838 were enrolled in this study, divided into the surgery-alone group (n = 649) and preoperative CRT group (n = 189), and analyzed. Results The following parameters were significantly lower in the CRT versus surgery-alone group: blood loss (210 vs. 431.5 mL), postoperative complications (27.5% vs 39.0%), and the incidence of anastomotic leakage (3.7% vs. 8.8%). The 3-year overall survival, relapse-free and local recurrence-free survival rates did not between the two groups to a statistically significant extent (91.2% vs. 87.4%, 68.8% vs. 66.4%, and 88.2% vs. 88.4%, respectively). Conclusions The present study revealed the current status of CRT for low rectal cancer in Japan. The results showed that CRT could be safely performed for advanced low rectal cancer in comparison to surgery alone. Keywords Preoperative CRT · Low rectal cancer · Long-term outcome · Short-term outcome * Masafumi Inomata inomata@oita‑u.ac.jp 1
Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1‑1 Idaigaoka, Hasama‑machi, Yufu‑City, Oita 879‑5593, Japan
2
Department of Surgery, Kitano Hospital, Kyoto, Japan
3
Department of Colorectal Surgery, Cancer Institute Center, Tokyo, Japan
4
Department of Colorectal Surgery, National Cancer Center, Tokyo, Japan
5
Department of Surgery, Okayama University, Okayama, Japan
6
Department of Colorectal Surgery, Tochigi Cancer Center, Utsunomiya, Japan
7
Department of Colorectal Surgery, Osaka Medical College, Osaka, Japan
8
Department of Surgery, Kyoto University, Kyoto, Japan
9
Department of Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
Introduction Rectal cancer has been treated by preoperative chemoradiotherapy (CRT) in Western countries for several decades now, and good local control has been attained [1–9]. However, the Japanese guidelines failed to strongly recommend CRT because it only achieves local control and offers no particular survival benefit [10]; thus, CRT is not frequently used in the treatment of low rectal cancer in Japan. Although CRT w
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