Effect of interval between neoadjuvant chemoradiotherapy and surgery on oncological outcomes in poor responders with locally advanced rectal cancer - a retrospective cohort study

Q: Why is the surgical interval after neoadjuvant CRT a controversial issue in locally advanced rectal cancer?

The optimal time between completing neoadjuvant CRT and performing surgery remains debated. Some evidence suggests delayed surgery may increase pathological complete response, but the prognostic impact for poor responders is unclear.

Q: How were poor responders and surgical interval groups defined in this study?

Poor responders were selected based on tumor regression grade 2–3. Patients were divided into a longer interval group (>8 weeks) and a shorter interval group (≤8 weeks) according to the wait time from CRT completion to surgery.

Sep 24, 2026

Uploaded by Aria Callaghan

Retrospective cohort study assessing how the wait time between completion of neoadjuvant chemoradiotherapy (CRT) and subsequent surgery influences oncological outcomes in poor responders with locally advanced rectal cancer. Patients receiving neoadjuvant CRT followed by total mesorectal excision were stratified by surgical interval: >8 weeks versus ≤8 weeks based on tumor regression grade 2–3. Longer interval showed worse overall survival and disease-free survival, with increased mortality and recurrence risk in multivariate analysis. Conclusion supports identifying poor responders via restaging MRI and proceeding to radical surgery without prolonged delay.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Background

Materials and methods

Study cohort and grouping

Results

Conclusion

Introduction

’Retrospective Cohort Study Effect of interval between neoadjuvant chemoradiotherapy and surgery on oncological outcomes in poor responders with locally advanced rectal cancer: a retrospective cohort study Dakui Luo, MDa,b , Yufei Yang, MDa,b , Ruijia Zhang, MDa,b , Qingguo Li, MDa,b,* , Xinxiang Li, MDa,b,* Background: The optimal interval from completion of neoadjuvant chemoradiotherapy (CRT) to surgery in locally advanced rectal cancer remains controversial. It seems that delayed surgery is associated with an increase in pathological complete response rates. However, the prognostic effect of delayed surgery in poor responders is unclear. Materials and methods: Patients with locally advanced mid or distal rectal cancer undergoing neoadjuvant CRT followed by total mesorectal excision at a university teaching cancer center between June 2010 and December 2018 were retrospectively reviewed in this study. According to the tumor regression grade, poor responders (tumor regression grade 2–3) to neoadjuvant CRT were selected for analyses. Patients were divided into the longer interval group (greater than 8 weeks) and the shorter interval group (8 weeks or less) based on the wait time from completion of neoadjuvant CRT therapy to surgery. Results: among 916 eligible patients, 522 patients had a poor tumor response. There were 217 patients in the shorter interval group and 305 patients in the longer interval group. At the baseline, patients in the longer interval group were more likely to have a T3 stage and positive vascular invasion. Compared with patients in the shorter interval group, patients in the longer interval group had signiﬁcantly worse overall survival and disease-free survival (DFS) (log-rank test, overall survival: P = 0.004, DFS: P < 0.001) . The 3-year DFS rates were 75 .6 and 63.1% in the shorter interval group and the longer interval group, respectively. In the multivariate analysis, delayed surgery was associated with an increased risk of mortality (hazard ratio: 2 .003, 95% CI: 1 .233–3.253, P = 0.005) and recurrence (hazard ratio: 1.555, 95% CI: 1 .121–2. 156, P = 0.008) . Conclusion: Patients who had a poor tumor response should be identiﬁed by restaging MRI and receive radical surgery in time, without a prolonged interval. Keywords: locally advanced rectal cancer, neoadjuvant chemoradiation, poor responders, surgical interval Introduction Neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision (TME) and adjuvant chemotherapy has been aDepartment of Colorectal Surgery, Fudan University Shanghai Cancer Center and bDepartment of Oncology, Shanghai Medical College, Fudan University, Shanghai, China D.L., Y.Y. and R.Z., contributed equally to this work. Sponsorships or competing interests that maybe relevant to content are disclosed atthe end of this article. *Corresponding author. Address: 270 Dong'an Road, Xuhui District, Shanghai 200032, China. Tel.: +86 021 [64175590. E-mail: xinxiangli@fudan.edu.cn](64175590. E-mail: xinxiangli@fudan.edu.cn) (X. Li); [E-mail: qingguoli@fudan.edu.cn](E-mail: qingguoli@fudan.edu.cn) (Q. Li). Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms. International Journal of Surgery (2023) 109:1993–2000 Received 2 September 2022; Accepted 1 May 2023 Supplemental Digital Content is available for this article. Direct URL citations are provided in the HTML and PDF versions of this article on the journal's website, [www.lww.com/international-journal-of-surgery](www.lww.com/international-journal-of-surgery). Published online 13 May 2023 [http://dx.doi.org/10.1097/JS9.0000000000000438](http://dx.doi.org/10.1097/JS9.00000000000

FAQs

Why is the surgical interval after neoadjuvant CRT a controversial issue in locally advanced rectal cancer?

The optimal time between completing neoadjuvant CRT and performing surgery remains debated. Some evidence suggests delayed surgery may increase pathological complete response, but the prognostic impact for poor responders is unclear.

How were poor responders and surgical interval groups defined in this study?

Poor responders were selected based on tumor regression grade 2–3. Patients were divided into a longer interval group (>8 weeks) and a shorter interval group (≤8 weeks) according to the wait time from CRT completion to surgery.

What effect did a longer surgical interval have on outcomes for poor responders?

Compared with the shorter interval group, the longer interval group had significantly worse overall survival and disease-free survival. Multivariate analysis also showed higher risks of mortality and recurrence with delayed surgery.

Sep 24, 2026

Uploaded by Aria Callaghan