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Short and long course neoadjuvant therapy compared for management of locally advanced rectal cancer: 11 years' experience at a regional centre
Author(s) -
Ngoo Alexander G.,
Tan Alexander H. M.,
Mushaya Chrispen D.,
Ho YikHong
Publication year - 2020
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.15660
Subject(s) - medicine , socioeconomic status , disadvantaged , colorectal cancer , univariate analysis , decile , multivariate analysis , demography , cancer , surgery , general surgery , population , environmental health , statistics , mathematics , sociology , political science , law
Abstract Background Rectal cancer treatment outcomes for socioeconomically disadvantaged and regional patients have been suggested to be suboptimal in Australia. We investigate outcomes at a regional tertiary centre in order to determine the prognostic impact of patient and treatment factors. Methods Patients who underwent short and long course neoadjuvant therapy followed by surgery for stage II–III rectal cancer over an 11‐year period were identified. Results were analysed to determine oncological and surgical outcomes along with whether patient and treatment‐related variables were prognostic. Accessibility/Remoteness Index of Australia (ARIA) and Index of Relative Socioeconomic Disadvantage (IRSD) was used to determine remoteness and socioeconomic status, respectively. Results A total of 207 patients underwent short ( n = 103, 49.8%) and long course ( n = 104, 50.2%) over the time period; 81.6% ( n = 169) were from outer regional, remote or very remote communities and 55.1% travelled >200 km for treatment; 57.0% were in the most disadvantaged three IRSD deciles. Five‐year cancer‐specific survival, recurrence‐free survival and local recurrence were 83.1% ( n = 172), 76.3% ( n = 158) and 7.3% ( n = 15), respectively. Wound complications were higher in outer regional, remote or very remote patients (25.4% versus 13.2%, P = 0.03). Remoteness, socioeconomic indices, distance to treatment and neoadjuvant type were not prognostic for any other oncological or surgical outcomes on univariate or multivariate analysis. Conclusions Despite demography suggesting geographic and socioeconomic barriers, oncological and surgical outcomes at our regional centre were comparable to international and Australian trials. Further, these factors were not prognostic. Geographically remote patient's may safely have neoadjuvant modality individualized without compromising care.