1. PRESENTATOR: MD VƯƠNG NHẤT PHƯƠNG. HO CHI MINH CITY ONCOLOGY HOSPITAL
INITIAL FINDINGS OF NEO-ADJUVANT CHEMORADIOTHERAPY COMBINED WITH SURGERY IN TREATMENT OF STAGE II – III RECTAL CANCER
PRESENTATOR: MD VƯƠNG NHẤT PHƯƠNG.
HO CHI MINH CITY ONCOLOGY HOSPITAL

2. INTRODUCTION Rectal cancer – 5th most popular cancer in Vietnam.
TME - reducing local recurrent rate.
In 1990, NCI (National Cancer Institute): Multi modality treatment - a new standard of rectal cancer treatment.
CAO/ARO/AIO-94 trial: Preoperative chemo radiotherapy on local recurrent rate of stage II, III rectal cancer (6% vs 13%).

3. The necessity of research
Bachmai Hospital and Hanoi K Institute - MD Phạm Cẩm Phương’s Clinical Trial
Ho Chi Minh City Oncology Hospital - Multi modality treatment (surgery combined with postoperative chemoradiotherapy) since 1990.

4. Research question
Pre-operative chemoradiotherapy vs Post-operative chemoradiotherapy in treatment of local advanced rectal cancer, combined with surgery.

5. General Objectives 2-year DFS and OS Radical resection rate
Sphincter preservation rate

6. Specific targets Findings: * 2-year DFS and OS * Radical resection
* Sphincter preservation
Comparing Operative difficulty levels:
* Operation time
* Blood loss
* Complication

7. Research recruitment Middle and low third local advanced rectal cancer
Adenocarcinoma
Department II of Ho Chi Minh city Oncology Hospital
From June 2014 to December 2015
Patients, Pathology, Admitted

8. Clinical trial >< Historical control.
Research method
Clinical trial >< Historical control.
Sample Size: 101 cases +

9. Criteria Recruitment vs. Elimination
Research Recruitment
Patients’ consent
Not adenocarcinoma
Emergency problems: bowel obstruction, peritonitis
Metastasis after neo-adjuvent chemoRT (carcinomatosis)

10. Preparation before treatment
Tattooing tumor location
Pelvic MRI

11. Patient positioning - Radiation

12. Radiotherapy simulation

13. Evaluation of neo-adjuvent chemoRT responsiveness

14. Patient positioning - Operation

15. Pelvic cavity Low anterior resection

16. Operative specimen
APR
PELVECTOMY
LOW ANTRIOR RESECTION

17. FOLLOW-UP
1ST - Adjuvant chemotherapy = Capecitabine / XELOX; 2ND - Colonoscopy.
3-month periodical examination.
Yearly schedule of Pelvic MRI & Colonoscopy.

18. Results
Study group = 119 cases
Historical control group =104 cases

19. Age
Gender

20. Tumor location
Tumor mobilization

21. Stage

22. Clinical Responsiveness
Pathological responsiveness

23. Operation P = 0.000* Fisher’s exact test
Operation type
Study group n = 119 cases
His. Control n = 104 cases
Unresectable
20 = 19,2%
Low anterior resection
75 = 63%
58 = 55,8%
Ultra low anterior resection
13 = 10,9%
Hartmann procedure
2 = 1,7%
5 = 4,8%
Miles procedure
27 = 22,7%
21 = 20,2%
Pelvectomy

24. Operation - Tumor ≤ 5cm from anus verge P = 0.000* Fisher’s exact test
Operation type
Study group n = 65 cases
His. control
n =47 cases
Unresectable
11 = 23,4%
Low anterior resection
26 = 40%
14 = 29,8%
Ultra low anterior resection
11 = 16,9%
Hartmann procedure
3 = 6,4%
Miles procedure
27 = 41,5%
19 = 40.4%
Pelvectomy
1 = 1,6%

25. Operation P = 0.000* Fisher’s exact test
Operation type
Study group
n = 119
His. Control
n = 104
Open surgery
91= 76,5%
100 = 96,2%
Laparoscopic surgery
28 = 23,5%
4 = 3,8%
Cutting merging
Study group n=119
His. control
n=104
Unresectable
20 = 19,3% R0
115 = 96,8%
81 = 77,9% R1
3 = 2,4%
2 = 1,9% R2
1 = 0,8%
1 = 0,9 %

26. Operation Time & Blood Loss
Study group
His. group
P (unequal variance)
Average operation time
120
115
Low anterior resection
120 ± 41,8 n=75
109,6 ± 27,8 n=53
0,067
Miles procedure
133 ± 27,9 n=27
122 ± 28.1 n=21
0,204
Hartmann procedure
117,5 ± 24,7 n=2
109 ± 15,9n=5
0,542
Blood loss (ml)
Study group
His. control
P (unequal variance)
Low anterior resection
70 ( )
70 ( )
0,572
Miles procedure
100( )
120 ( )
0,374
Hartmann procedure
125 ± 35,3
90 ± 14.1
0,093

27. Complication and mortality
Description
Study group
His. group
Anastomosis leaked
2cases = 2,2%
2cases = 3,4%
Bowel obstruction
3cases = 2,4%
3cases = 2,7%
Necrosis colostomy
1cases = 0,8%
Recto-vaginal fistule
1cases = 1,7%
Intestineperineal fistule
Mortality

28. Conclusion Increase in radical resection and sphincter preservation
No negative impact on operation safety
FOLLOWED UP 2-YEAR DFS & OS
SUGGESTION: Standard Multi-Modality Regimen for Middle and Low third Local advanced Rectal Cancer.

29. Thank you.