Consent for Anterior Resection: How Well Do We Consent for Surgical Risks?

Résumé fourni par la source

Aim: This study aimed to determine whether the use of neoadjuvant therapy modifies the ability of TNM staging to discriminate prognosis by stage for rectal cancer patients undergoing resection.Method: Patients with histologically confirmed rectal adenocarcinoma undergoing major resection were identified from the SEER database from 1998 to 2013.Kaplan-Meier curves were used to determine 5-year cancer specific survival (CSS) and multivariable Cox regression used to produce adjusted hazard ratios (HR).Result: From 44,638 patients, 14,718 (33%) received neoadjuvant radiotherapy.For stage 1 disease, neoadjuvant radiotherapy was associated with reduced CSS compared to without neoadjuvant therapy (88% versus 93%, HR 1.75, 1.51-2.03).However, for stage 2 and stage 3 disease, neoadjuvant radiotherapy was associated with improved CSS (stage 2: 82% versus 81%, HR 0.59, 0.55-0.64;stage 3: 74% versus 67%, HR 0.76, 0.71-0.82).In patients achieving negative circumferential resection margin (CRM), those downstaged to stage 1 were associated with improved survival compared to those with stage 2 (HR 1.61, 1.39-1.86)or stage 3 disease (2.79, HR 2.42-3.23).Conclusion: There are stage-by-stage survival differences for patients treated with and without neoadjuvant radiotherapy.A revised staging system that stratifies patient according to neoadjuvant therapy may be more accurate.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.