Effect of centre volume on pathological outcomes and postoperative complications after surgery for colorectal cancer: results of a multicentre national study

Short-term surgical outcomes of rectal adenocarcinoma surgical treatment in Latin America: a multicenter, retrospective assessment in 49 centers from 12 countries

INTRODUCTION

Rectal cancer is a prevalent disease that requires multidisciplinary management. Results of treatment of patients suffering from this malignancy in Latin America have been scarcely reported before.

METHODS

A retrospective, multicenter study was conducted to report preoperative and operative characteristics of patients intervened for rectal cancer in centers from Latin America during 2015-2022, and the short-term results of treatment were analyzed. The study was open to any center receiving rectal cancer patients, irrespective of volume. The main study outcome was 30-day postoperative complications including any deviation from the normal postoperative course (Clavien Dindo I to V).

RESULTS

A total of 2044 patients from 49 centers in 12 Latin American countries were included, with a mean age of 63 years. Twenty-five percent of patients were operated in low-volume centers. Twenty-nine percent of patients had a tumor located in the low rectum, and only 53% of patients had preoperative MRI for local staging. A total of 1052 patients (52%) received neoadjuvant therapy before surgery. Eighty-six percent of patients were operated by a specialized colorectal surgeon, and 31% of patients were intervened using a conventional approach. A total of 29.9% of patients presented a postoperative complication. The anastomotic leak rate was 8.9%. Fifty-eight percent of pathology reports had less than 12 lymph nodes harvested, and 22.9% of reports did not include mesorectal quality. In the multivariate analysis, neoadjuvant therapy (OR: 1.44, p-value: 0.023), urgent procedures (OR: 3.73, p-value: 0.049), intraoperative complications (OR: 2.21, p-value: 0.046), advanced tumors (OR: 1.39, p-value: 0.036), and prolonged surgery (OR: 1.74, p-value: 0.004) were found to be independently related to suffering postoperative complications.

CONCLUSIONS

This study includes information about the approach and results of rectal cancer management in Latin America at a large scale. In the future, this information can be used as a bridge to identify areas of improvement among rectal cancer patients' treatment in the region.

Trends and Outcomes of Neoadjuvant Chemotherapy for Clinical Stage T1 Pancreatic Cancer

BACKGROUND

Neoadjuvant chemotherapy (NC) for early pancreatic ductal adenocarcinoma (PDAC) remains controversial. We investigate the adoption of NC and its impact on survival in clinical T1 (cT1) PDAC.

METHODS

National Cancer Database (2006-2017) was reviewed for cT1 PDAC. Patients receiving NC and surgery were compared with patients undergoing upfront surgery (US).

RESULTS

A total of 5886 patients were included. NC use increased from 4.8% in 2006 to 18.8% in 2017. The NC group (n = 618) versus the US group (n = 5268) had: younger age (66 years vs. 68 years), smaller tumor size (2 cm vs. 2.2 cm), more pancreas head tumors (77% vs. 70.6%), lower lymph-vascular invasion (25.9% vs. 40.6%), and less lymph node positivity (43.6% vs. 54.5%), p < 0.001. Factors associated with receipt of NC were: younger age, recent year of diagnosis, and treatment at an academic program. In the NC group versus the US group, median OS was 35.2 months versus 28.3 months, p < 0.001. Factors associated with improved survival included: well differentiated pathology, R0 surgical margins, and receipt of chemotherapy.

CONCLUSION

In cT1 PDAC, chemotherapy is associated with improved survival. In a surgery-first approach, only 59% of patients receive adjuvant chemotherapy. These data suggest consideration of neoadjuvant therapy for early pancreatic cancer.