Locally Advanced Rectal Cancer Neoadjuvant Chemoradiotherapy Complication After Operation And Pathological Response Analysis

ObjectivesAnalysis the pathological reaction and operation complications of locally advanced rectal cancer with neoadjuvant chemoradiation.Materials and MethodsSixty-eight locally advanced rectal cancer cases with neoadjuvant chemoradiotherapy and operation were collected in our hospital. Fifty of them were men and18were women, the median age was59years (range30-77years). For the clinical TNM stage, there were35cases of stage II, including26patients in stage II a,9patients in stage Ⅱb; There were23cases of stage III, including1patient in stage Ⅲa,17patients in stage Ⅲb,5patients in stage Ⅲc; the other9cases were of stage IV. The radiotherapy prescription doses were as follows:for conventional radiotherapy plan, the target doses were40-48Gy,2Gy/F; for3D-CRT or EMRT plan, the target dose were45-50.4Gy for PTV1in25-28fractions. All the patients received concurrent chemoradiotherapy with platinum based two-drug regiments or Xeloda. Operation was performed25-69days after the completion of concurrent chemoradiotherapy, bleeding volumes in surgery were recorded, the tumor pathological responses were evaluated, the complications during perioperative period were also observed.ResultsAll of the patients completed the concurrent chemoradiotherapy,57.1%patients received Sphincter preserving operation. In19cases of patients, the intraoperative blood loss was less than50ml (27.9%), those with intraoperative blood loss of50-200ml,201-400ml, and more than400ml were32cases (47.1%),13cases (19.1%), and3cases (4.4%), respectively. The average intraoperative blood loss was183ml. Postoperative anastomotic leakage occurred in3cases (4.4%), wound infection occurred in4cases (5.9%), the whole group without the occurrence of ileus. Pathological complete response was seen in9cases of patients with neoadjuvant chemoradioation (14.7%). The pre-therapy clinical stages and pathological stages were compared, lower ypT stage was seen in33cases (48.5%) of patients when compared with cT stage, and lower ypN stage was seen in16cases (23.5%) of patients when compared with cN stage. As regards to the TNM stage, there were34cases (50%) of patients with ypTNM stage lower than cTNM stage.Conclusion1. Neoadjuvant chemoradiotherapy do not increase complications (e.g., bleeding, anastomotic fistula, incision infection and ileus) of the patients with the local advanced rectal cancer.2. Pathological complete response was seen in14.7%of the locally advanced rectal cancer treated with neoadjuvant chemoradiation. The cancer cells of primary tumor of disappeared after neoadjuvant chemoradiotherapy in16.2%locally advanced rectal cancer patients3. Down stage of the primary rectal cancer was found in48.5%of locally advanced rectal cancer patients treated with neoadjuvant chemo-radiotherapy.4. For the locally advanced rectal cancer cases with negative lymph node in pretreatment clinical staging,80%of the patients were found to be lymph node negative pathologically, after concurrent chemoradiotherapy.