The impact of neoadjuvant chemoradiotherapy and surgical technique on pathological and early oncological outcomes in rectal cancer

Objective This study aims to evaluate the impact of neoadjuvant chemoradiotherapy (CRT) and different surgical techniques on pathological and early oncological outcomes in the treatment of rectal cancer. The effects of appropriate surgical procedures and neoadjuvant therapies on survival rates, recurrence rates, and pathological responses in rectal cancer treatment were investigated. Materials and Methods The study was conducted on 158 patients who underwent surgery for rectal cancer at Akdeniz University Faculty of Medicine between January 2019 and December 2023. The study was designed retrospectively, and the patients' demographic characteristics, surgical procedures, stages, neoadjuvant treatment status, and pathological findings were evaluated. Factors affecting survival and recurrence rates were analyzed using statistical methods. Results The mean age of the patients was 63.1±12.4 years, with 63,3% being male. Low anterior resection was performed to 113 (70.1%) patients, while abdominoperineal resection was performed to 45 (28.5%) patients. Open surgery was applied to 78 (49.3%) patients, laparoscopic surgery to 52 (33%), and robotic surgery to 28 (17.7%) patients. A total of 113 (71.5%) patients received neoadjuvant chemoradiotherapy (CRT). The complete pathological response rate in patients who received CRT was 18.6%, with a decrease in the average number of lymph nodes identified in the specimens. The overall survival time was 47.3±2.2 months, and the survival rate was 78.8% in the CRT group compared to 60% in the non-CRT group (p=0.015). The recurrence rate was 20%. Lymphovascular invasion (LVI), perineural invasion (PNI), positive lymph node status, advanced stage, and recurrence were identified as poor prognostic factors. Conclusion Neoadjuvant CRT increases survival rates in the treatment of rectal cancer. Although open surgery resulted in the removal of more lymph nodes compared to laparoscopic and robotic surgery, no significant difference was observed in overall survival between surgical techniques. While no association was found between the number of lymph nodes removed (whether more or less than 12) and survival, lymph node positivity, complete pathological response, LVI and PNI, and tumor stage were identified as significant prognostic factors for survival and recurrence.