The Time Between Chemoradiation and Surgery for Rectal Carcinoma Negatively Influences Mesorectal Excision Quality

  • Igor Sirák
  • Denisa Pohanková
  • Alexander Ferko
  • Eva Hovorková
  • Tomáš Rozkoš
  • Milan VošmikEmail author
  • Miroslav Hodek
  • Petr Paluska
  • David Buka
  • Jakub Grepl
  • Jiří Petera
Original Article


Total mesorectal excision quality (TMEq) is a prognostic factor associated with local recurrence in rectal adenocarcinoma. Neoadjuvant chemoradiotherapy (NCRT) reduces the risk of tumor recurrence, but may compromise TMEq. The time between NCRT and surgery (TTS) and how it influences TMEq and tumor control were evaluated. In prospective registry, 236 patients after NCRT and TME were analyzed. NCRT involved radiotherapy with 45 Gy to the pelvis, plus tumor boost dose 5.4 Gy with concurrent 5-fluorouracil infusion. NCRT was followed by TME after 9 weeks on average (median 9.4 ± SD 2.5). TMEq was parametrically analyzed by standard three-grade system. With median follow-up of 47.5 months, 3-year overall survival (OS) was 83.8%, disease-free survival (DFS) was 77.7%, and 6.4% was the rate of local recurrence (LR). TTS was not associated with OS, DFS, or LR. TMEq was found to be associated with LR in univariate analysis, but not in multivariate, where pathological tumor stage and resection margins remained dominant predictors. TMEq was negatively influenced by inferior location of the tumor, longer TTS, higher tumor and nodal stage, presence of tumor perforation, perineural invasion, and close/positive resection margins. Nonetheless, TTS remained a strong predictor of TMEq in multivariate analyses. TTS was proven to be an independent predictor of TMEq. With longer TTS, fewer complete TME with intact mesorectal plane were observed. However, TTS was not associated with survival deterioration or tumor recurrence. These were negatively influenced by other factors interfering with TMEq, especially by pathological tumor stage and resection margins.


Rectal carcinoma Neoadjuvant chemoradiation Mesorectal excision 



The review was supported by Progres Q40/06 – Charles University in Prague, and by Czech Republic Ministry of Health MHCZ-DRO (UHHK, 00179906). The authors would like to thank Dr. Ian McColl for proof-reading the manuscript. This paper contains data already published at ASTRO 2018 Annual Meeting (Int J Radiat Oncol Biol Phys 2018;102(3)S:E19, DOI:

Compliance with Ethical Standards

Conflict of Interest

All authors declare no conflict of interest.


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Copyright information

© Arányi Lajos Foundation 2019

Authors and Affiliations

  • Igor Sirák
    • 1
  • Denisa Pohanková
    • 1
  • Alexander Ferko
    • 2
  • Eva Hovorková
    • 3
  • Tomáš Rozkoš
    • 3
  • Milan Vošmik
    • 1
    Email author
  • Miroslav Hodek
    • 1
  • Petr Paluska
    • 1
  • David Buka
    • 1
  • Jakub Grepl
    • 1
  • Jiří Petera
    • 1
  1. 1.Department of Oncology and RadiotherapyUniversity Hospital in Hradec KraloveHradec KrálovéCzech Republic
  2. 2.Department of Surgery and Transplant centre, Jessenius Faculty in Martin, University Hospital MartinComenius University BratislavaBratislavaSlovak Republic
  3. 3.Fingerland Department of PathologyUniversity Hospital in Hradec KrálovéHradec KrálovéCzechia

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