Comparing early surgical outcomes between total neoadjuvant therapy and standard long course chemoradiotherapy for rectal cancer

Table 1 Baseline demographic and clinicopathological characteristics of patients treated with rectal cancer and preoperative induction therapy followed by dedicated operation vs standard long course chemoradiotherapy, mean ± SD/n (%)

Characteristic	TNT-RAPIDO (n = 29)	LCCRT (n = 70)	P value
Age (years)	58.2 ± 1.9a	64.7 ± 1.3a	0.007
Gender			0.786
Male	24 (82.8)	55 (78.6)
Female	5 (17.2)	15 (21.4)
BMI	23.8 ± 0.8	23.1 ± 0.5	0.415
ECOG performance status			0.309
0	16 (55.2)	30 (42.9)
1	13 (44.8)	33 (47.1)
2	0	7 (10.0)
MRI T stage			0.082
1	0	0
2	1 (3.4)	4 (5.7)
3	20 (69.0)	59 (84.3)
4	8 (27.6)	7 (10.0)
MRI N stage			0.638
0	2 (6.9)	8 (11.4)
1	15 (51.7)	39 (55.7)
2	12 (41.4)	23 (32.9)
EMVI			0.660
Positive	16 (55.2)	34 (48.6)
Negative	13 (44.8)	36 (51.4)
CRM			0.235
Positive	18 (62.1)	52 (74.3)
Negative	11 (37.9)	18 (25.7)
PSW			0.597
Positive	5 (17.2)	17 (24.3)
Negative	24 (82.8)	53 (75.7)
Interval to surgery [weeks; median (interquartile range)]	29.9 (24.0-33.7)a	19.0 (16.1-21.3)a	< 0.001
Mode of surgery			0.089
Open	0	4 (5.7)
Laparoscopic	10 (34.5)	36 (51.4)
Robotic	19 (65.5)	30 (42.9)

^aP < 0.05.

BMI: Body mass index; ECOG: Eastern Cooperative Oncology Group; MRI: Magnetic resonance imaging; T: Tumor; N: Node; EMVI: Extramural venous invasion; CRM: Circumferential resection margin; PSW: Pelvic sidewall; TNT: Total neoadjuvant therapy; RAPIDO: Rectal cancer and preoperative induction therapy followed by dedicated operation; LCCRT: Long course chemoradiotherapy.

Table 2 Comparative surgical outcomes: Rectal cancer and preoperative induction therapy followed by dedicated operation vs standard long course chemoradiotherapy, median (interquartile range)/mean ± SD/n (%)

Outcome	TNT-RAPIDO (n = 29)	LCCRT (n = 70)	P value
Duration of operation (minutes)	306.5 (267-380)	372.5 (310-455)	0.111
Intraoperative complication			0.502
Yes	1 (3.4)	1 (1.4)
No	28 (96.6)	69 (98.6)
Conversion			0.318
Yes	0	4 (5.7)
No	29 (100.0)	66 (94.3)
30-day morbidity			0.656
Yes	10 (34.5)	28 (40.0)
No	19 (65.5)	42 (60.0)
Clavien-Dindo classification			0.286
Grade I	2 (6.9)	11 (15.7)
Grade II	5 (17.2)	14 (20.0)
Grade III	3 (10.3)	3 (4.3)
30-day mortality	0	0
Length of stay (days)	7 (5-10.5)	9.5 (5-17)	0.279
R0 resection			0.625
Yes	27 (93.1)	63 (90.0)
No	2 (6.9)	7 (10.0)
TME completeness			0.422
Yes	29 (100.0)	66 (94.3)
No	0	4 (5.7)
Distal margin (cm)	3.1 ± 0.5	3.0 ± 0.2	0.827
Total LN harvested	40.7 ± 3.4a	23.4 ± 1.6a	< 0.001
Positive LN	1.8 ± 0.5	1.8 ± 0.3	0.973
Pathological complete response rate (%)	13.8	10.0	0.726
Duration with stoma (weeks)	27.1 ± 3.6a	42.5 ± 3.8a	0.013
Permanent stoma rate (%)	13.8a	35.7a	0.031

^aP < 0.05.

TME: Total mesorectal excision; LN: Lymph node; TNT: Total neoadjuvant therapy; RAPIDO: Rectal cancer and preoperative induction therapy followed by dedicated operation; LCCRT: Long course chemoradiotherapy.