Neoadjuvant chemoradiotherapy with capecitabine followed by laparoscopic resection in locally advanced tumors of middle and low rectum - toxicity and complications of the treatment.

AIMS: The aim of this prospective study is to elucidate feasibility of protocol of neoadjuvant concomitant radiochemotherapy with capecitabine and long course radiotherapy with subsequent laparoscopic rectal resection. We assessed treatment toxicity, downstaging rate, pathological response to the neoadjuvant treatment, surgery complications, rate of conversions and sphincter-preserving surgical procedures, and intraoperative and early postoperative complications too. METHODS: We acquired data of 78 patients from 1 January 2005 to 31 December 2007 with a locally advanced rectal cancer in our study. All patients were indicated for the neoadjuvant concomitant chemoradiotherapy due to locally advanced tumor (T3 or T4) or lymph nodes involvement suspicion (N+). Both radiotherapy (to pelvic region) and chemotherapy (capecitabine) were administered. Rectal tumors were localized within 12 cm from the anocutaneous verge. The average follow-up time was 23.9 months. RESULTS: All patients completed their treatment according to the planned regimen and dose. The surgery was performed laparoscopicaly within 4-8 weeks following the concomitant chemoradiotherapy - in 17% cases was converted into conventional surgery. Downstaging was achieved in 69% of patients, pathological complete response in 10%, histologically negative lymph nodes were documented in 58% of patients. Grade 3 toxicity of the concomitant chemoradiotherapy was present in 3%; grade 2 in 29% of patients, particularly skin and gastrointestinal form. Intraoperative and early postoperative complications of the surgery were 18%. Re-operation was needed in 5% cases. CONCLUSIONS: We demonstrated safety and low toxicity of the concomitant chemoradiotherapy with capecitabine.

[Laparoscopic resection of rectal cancer: evaluation of perioperative results of the primary resection and resection after preoperative chemoradiotherapy]. / Laparoskopická resekcia karcinómu rekta: zhodnotenie perioperacných výsledkov primárnej resekcie a resekcie po neoadjuvantnej chemorádioterapii.

AIMS: To evaluate and compare perioperative results of laparoscopic resection for low and middle third rectal cancer subgroup of patients intended for primary resection (PR) with those operated after chemoradiotherapy (CHRT). METHODS: 291 patients were operated for rectal cancer during the years 2005-2007 in Department of Surgery, J. G. Mendel Oncological Centre Nový Jicín. 155 patients (49 women and 106 men, mean age 65 +/- 9.7, range 27-87) having laparoscopic resection for low and middle rectal cancer were included in the present prospective single centre study. Primary surgical approach was adopted in 74 patients and 81 patients had a preoperative chemoradiotherapy. RESULTS: Both groups were comparable regarding intraoperative (p = 0.632) and postoperative surgical complications (p = 0.179) and nonsurgical complications (p = 0.654) too. Operative time and postoperative stay were similar in both groups. Number of harvested lymphnodes was higher for PR group (p < 0.001). CONCLUSION: In summary, after short term results evaluation, there is no significant difference for PR and CHRT groups in laparoscopic rectal resection. Neoadjuvant chemoradiotherapy did not lead to worsening of the perioperative results of our patients.