Publication:

Oncological outcomes of obstructed locally advanced rectal cancer in the era of multi-modal therapy

Background The management of locally advanced rectal cancer is multi-modal. In India, a number of patients present with features of intestinal obstruction and are diverted prior to initiation of chemo-radiation therapy. The purpose of this paper is to study the demographics and oncological outcomes of obstructed locally advanced rectal cancer (OLARC) requiring pre-therapy diversion colostomy in comparison with patients who did not need pre-treatment diversion (non-obstructed group).

Methods This is a retrospective analysis of a prospective data-base. Patients diagnosed with non-metastatic locally advanced adenocarcinoma of the rectum in a colorectal unit of a tertiary care teaching hospital between August 2012 and December 2014 were analyzed. Data was collected from hospital records and telephonic interviews.

Results Two hundred and thirteen patients were diagnosed to have locally advanced rectal cancer.  One hundred and fifty patients (70.4%) did not have features of intestinal obstruction and received NACRT upfront and 63 (29.6%) required pre-therapy diversion colostomy. Thirty-nine patients (61.9%) completed therapy (neo-adjuvant chemo-radiotherapy followed by Surgery and adjuvant chemotherapy) in the obstructed group, compared to 127(84.7%) in the non-obstructed group (0<0.05) who completed all components of cancer directed therapy.  The 3-year overall survival (OS) of the obstructed and non-obstructed groups was 59% vs 90% (p<.001) and the disease-free survival (DFS) was 51% and 76% (p<0.01) respectively.

Conclusions In the era of multi-modal therapy, patients with obstructed locally advanced rectal cancer have worse oncological outcomes with respect to overall and disease-free survival.