Delaying surgery by more than 10 weeks after long-course neoadjuvant radiotherapy in locally advanced rectal cancer patients improves pathologic complete response



We currently do not know the optimal time interval between the end of chemoradiotherapy and surgery. Longer intervals have been associated with a higher pathological response rate, worse pathological outcomes and more morbidity. The aim of this study was to evaluate the effect and safety of the current trend of increasing time interval between the end of chemoradiotherapy and surgery (< 10 weeks vs. ≥ 10 weeks) on postoperative morbidity and pathological outcomes. This study analyzed 232 consecutive patients with locally advanced rectal cancer treated with long-course neoadjuvant chemoradiotherapy from January 2012 to August 2018. 125 patients underwent surgery before 10 weeks from the end of chemoradiotherapy (Group 1) and 107 patients underwent surgery after 10 or more weeks after the end of chemoradiotherapy (Group 2). Results have shown that wait for ≥ 10 weeks did not compromise surgical safety. Pathological complete response and tumor stage was statistically significant among groups. The effect of wait for ≥ 10 weeks before surgery shown higher tumor regression than the first group (Group 1, 12.8% vs Group 2, 31.8%; p < 0.001). On multivariate analysis, wait for ≥ 10 weeks was associated with pathological compete response. Patients from the second group were four time more likely to achieve pathologic complete response than patients from the first group (OR, 4.27 95%CI 1.60–11.40; p = 0.004). Patients who undergo surgery after ≥ 10 weeks of the end of chemoradiotherapy are four time more likely to achieve complete tumor remission without compromise surgical safety or postoperative morbidity.

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Researchers collaborating with the study: Dr. Núria Gómez Romeu, Dr. Júlia Gil, Dr. Anna Pigem, Dr. Ander Timoteo, Dr. Núria Ortega, Dr. Madalina Frunza.


There was no external financing to carry out the project.

Author information




Pere Planellas Giné, MD, PhD: study concept, execution, data interpretation and drafting of manuscript. Lídia Cornejo Fernández, MsC: design, statistical analysis and drafting of manuscript. Helena Salvador Rosés, MD, PhD: design, analysis and final manuscript review. Maria Buxó Pujolras, MsC: statistical analysis and manuscript review. Ramon Farrés Coll, MD: analysis and review. Xavier Hernandez Yague, MD: analysis and review. Eugeni Canals Subirats, MD: analysis and review. Júlia Gil Garcia, MD: analysis and review. Jose Ignacio Rodríguez Hermosa, MD, PhD: analysis and review. Antoni Codina Cazador, MD, PhD: design, analysis and final manuscript review.

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Correspondence to Pere Planellas Giné.

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The study was approved by the Ethics Committee of University Hospital Dr. Josep Trueta (No 20817/2017).

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Planellas Giné, P., Cornejo Fernández, L., Salvador Rosés, H. et al. Delaying surgery by more than 10 weeks after long-course neoadjuvant radiotherapy in locally advanced rectal cancer patients improves pathologic complete response . Updates Surg 72, 453–461 (2020).

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  • Rectal cancer
  • Radiotherapy
  • Interval
  • Long course