Neoadjuvant chemoradiotherapy is associated to higher postoperative complications and inferior long-term oncological survival outcomes in patients with proximal rectal cancers when compared with upfront surgery

Background: The role of preoperative chemoradiotherapy (CRT) in the management of proximal rectal cancer (PRC) is still debated. The purpose of this study was to compare perioperative and long-term oncological outcomes between PRC patients undergoing CRT + surgery and upfront surgery. Methods A total of 157 patients were retrospectively included in this study (131 treated with upfront surgery and 26 with CRT). CRT and upfront surgery groups were compared in terms of perioperative and long-term oncological outcomes. Results CRT group of patients was associated with higher rate of overall postoperative complications (42.3% vs. 18.3%, p < 0.05) and class III-IV complications (15.4% vs. 8.4%, p < 0.05). The 3 and 5-years overall survival (OS) rates for upfront surgery and CRT group were: 96.1%, 91.5% and 95.8%, 71.7% (p < 0.05), respectively. The 3 and 5-years disease-free survival (DFS) rates for upfront surgery and CRT were: 92.4%, 86.8% and 90.6%, 68.6% (p < 0.05), respectively. Conclusion The omission of CRT in patients with PRC did not impair the perioperative and long-term oncological outcomes. CRT is associated to higher complications rates and severity and to worst OS and DFS.