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1Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Copyright © 2021 The Korean Society of Coloproctology
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
No potential conflicts of interest relevant to this article were reported.
Variable |
Before propensity score matching |
After propensity score matching |
||||
---|---|---|---|---|---|---|
NAC (+) (n=66) | NAC (–) (n=363) | P-value | NAC (+) (n=60) | NAC (–) (n=60) | P-value | |
Age (yr) | 54 ± 11 | 60 ± 12 | < 0.001 | 53 ± 11 | 56 ± 11 | 0.098 |
Body mass index (kg/m2) | 23.2 ± 2.8 | 23.4 ± 2.9 | 0.519 | 23.2 ± 2.8 | 23.1 ± 2.7 | |
Sex | 0.489 | 0.752 | ||||
Male | 37 (56.1) | 220 (60.6) | 31 (51.7) | 35 (58.3) | ||
Female | 29 (43.9) | 143 (39.4) | 29 (48.3) | 25 (41.7) | ||
Preoperative CEA (ng/mL) | 0.607 | 0.854 | ||||
<5 | 35 (53.0) | 180 (49.6) | 34 (56.7) | 33 (55.0) | ||
≥5 | 31 (47.0) | 183 (50.4) | 26 (43.3) | 27 (45.0) | ||
ASA PS classification | 0.691 | 0.697 | ||||
I, II | 62 (93.9) | 336 (92.6) | 56 (93.3) | 57 (95.0) | ||
III, IV | 4 (6.1) | 27 (7.4) | 4 (6.7) | 3 (5.0) | ||
Pathology T stage | 0.001 | 0.762 | ||||
T1/T2 | 10 (15.2) | 16 (4.4) | 7 (11.7) | 5 (8.3) | ||
T3/T4 | 56 (84.8) | 347 (95.6) | 53 (88.3) | 55 (91.7) | ||
Pathology N stage | 0.749 | 0.452 | ||||
N0 | 12 (18.2) | 73 (20.2) | 9 (15.0) | 13 (21.7) | ||
N1 | 29 (43.9) | 137 (37.7) | 26 (43.3) | 20 (33.3) | ||
N2 | 25 (37.9) | 153 (42.1) | 25 (41.7) | 27 (45.0) | ||
Segmental involvement | < 0.001 | 0.539 | ||||
1 | 15 (22.7) | 199 (54.8) | 15 (25.0) | 22 (36.7) | ||
2 | 21 (31.8) | 107 (29.5) | 20 (33.3) | 15 (25.0) | ||
3 | 9 (13.6) | 24 (6.6) | 8 (13.3) | 8 (13.3) | ||
≥4 | 21 (31.8) | 33 (9.1) | 17 (28.3) | 15 (25.0) | ||
Location of primary tumor | 0.225 | 0.367 | ||||
Right colon | 10 (15.2) | 89 (24.5) | 8 (13.3) | 14 (23.3) | ||
Left colon | 35 (53.0) | 180 (49.6) | 33 (55.0) | 29 (48.3) | ||
Rectum | 21 (31.8) | 94 (25.9) | 19 (31.7) | 17 (28.4) | ||
Size of primary tumor (cm) | 3.9 ± 2.0 | 5.4 ± 2.0 | < 0.001 | 4.0 ± 2.0 | 4.3 ± 2.1 | 0.660 |
Liver metastatic lesion sizea (cm) | 2.6 ± 1.9 | 2.5 ± 1.2 | 0.434 | 2.7 ± 2.0 | 2.4 ± 1.2 | 0.335 |
Values are presented as number (%) or mean±standard deviation if otherwise specified.
NAC, neoadjuvant chemotherapy; NA, not applicable; FOLFOX, fluorouracil, leucovorin, oxaliplatin; FOLFIRI, fluorouracil, leucovorin, irinotecan; XELOX, capecitabine, oxaliplatin; XELIRI, capecitabine, irinotecan; MSI, microsatellite instability; MSS, microsatellite stable; MSI-H, MSI high; MSI-L, MSI low.
Target agent: bevacizumab or cetuximab.
Variable |
Before propensity score matching |
After propensity score matching |
||||
---|---|---|---|---|---|---|
NAC (+) (n=66) | NAC (–) (n=363) | P-value | NAC (+) (n=60) | NAC (–) (n=60) | P-value | |
Hepatectomy | < 0.001 | 0.715 | ||||
Majora | 36 (54.5) | 114 (31.4) | 32 (53.3) | 30 (50.0) | ||
Minorb | 30 (45.5) | 249 (68.6) | 28 (46.7) | 30 (50.0) | ||
Primary tumor resection | 0.042 | 0.307 | ||||
RHC | 11 (16.7) | 88 (24.2) | 9 (15.0) | 11 (18.3) | ||
LHC | 0 (0) | 20 (5.5) | 0 (0) | 2 (3.3) | ||
AR/LAR/uLAR/ISR | 55 (83.3) | 255 (70.3) | 51 (85.0) | 47 (78.4) | ||
Surgical approach | 0.121 | 0.850 | ||||
Open | 42 (63.6) | 265 (73.0) | 38 (63.3) | 37 (61.7) | ||
MIS | 24 (36.4) | 98 (27.0) | 22 (36.7) | 23 (38.3) | ||
Stoma formation | 13 (19.7) | 44 (12.1) | 0.095 | 13 (21.7) | 6 (10.0) | 0.080 |
Values are presented as number (%).
NAC, neoadjuvant chemotherapy; RHC, right hemicolectomy; LHC, left hemicolectomy; AR, anterior resection; LAR, low anterior resection; uLAR, ultra-low anterior resection, ISR, intersphincteric resection; MIS, minimal invasive surgery.
aRHC, extended RHC, LHC, and central hepatectomy.
bLeft lateral sectionectomy, segmentectomy, non-anatomic resection.
Variable |
Before propensity score matching |
After propensity score matching |
||||
---|---|---|---|---|---|---|
NAC (+) (n=66) | NAC (–) (n=363) | P-value | NAC (+) (n=60) | NAC (–) (n=60) | P-value | |
Operation time (min) | 336 ± 112 | 297 ± 103 | 0.005 | 334 ± 112 | 312 ± 120 | 0.304 |
Transfusion | 10 (15.2) | 49 (13.5) | 0.720 | 9 (15.0) | 10 (16.7) | 0.803 |
Time to soft diet (day) | 2.9 ± 1.4 | 3.0 ± 1.2 | 0.852 | 2.8 ± 1.2 | 2.8 ± 1.0 | 0.869 |
Length of hospital stay (day) | 14±8 | 14±8 | 0.993 | 14±9 | 13±7 | 0.687 |
Postoperative mortality (< POD 30)a | 0 (0) | 2 (0.6) | 0.546 | 0 (0) | 0 (0) | > 0.999 |
Postoperative morbidity | 24 (36.4) | 132 (36.4) | > 0.999 | 22 (36.7) | 23 (38.3) | 0.850 |
Bile leakage | 2 (3.0) | 9 (2.5) | 0.680 | 2 (3.3) | 4 (6.7) | 0.402 |
Surgical site infection | 9 (13.6) | 49 (13.5) | 0.976 | 8 (13.3) | 6 (10.0) | 0.570 |
Ileus | 7 (10.6) | 37 (10.2) | 0.919 | 5 (8.3) | 4 (6.7) | 0.729 |
Anastomotic leakage | 2 (3.0) | 19 (5.2) | 0.755 | 2 (3.3) | 3 (5.0) | 0.648 |
Intraabdominal fluid collection | 4 (6.1) | 21 (5.8) | 0.930 | 4 (6.7) | 4 (6.7) | > 0.999 |
Intraabdominal bleeding | 1 (1.5) | 5 (1.4) | 0.930 | 1 (1.7) | 2 (3.3) | 0.559 |
Variable | Before propensity score matching |
After propensity score matching |
||||
---|---|---|---|---|---|---|
NAC (+) (n=66) | NAC (–) (n=363) | P-value | NAC (+) (n=60) | NAC (–) (n=60) | P-value | |
Age (yr) | 54 ± 11 | 60 ± 12 | < 0.001 | 53 ± 11 | 56 ± 11 | 0.098 |
Body mass index (kg/m2) | 23.2 ± 2.8 | 23.4 ± 2.9 | 0.519 | 23.2 ± 2.8 | 23.1 ± 2.7 | |
Sex | 0.489 | 0.752 | ||||
Male | 37 (56.1) | 220 (60.6) | 31 (51.7) | 35 (58.3) | ||
Female | 29 (43.9) | 143 (39.4) | 29 (48.3) | 25 (41.7) | ||
Preoperative CEA (ng/mL) | 0.607 | 0.854 | ||||
<5 | 35 (53.0) | 180 (49.6) | 34 (56.7) | 33 (55.0) | ||
≥5 | 31 (47.0) | 183 (50.4) | 26 (43.3) | 27 (45.0) | ||
ASA PS classification | 0.691 | 0.697 | ||||
I, II | 62 (93.9) | 336 (92.6) | 56 (93.3) | 57 (95.0) | ||
III, IV | 4 (6.1) | 27 (7.4) | 4 (6.7) | 3 (5.0) | ||
Pathology T stage | 0.001 | 0.762 | ||||
T1/T2 | 10 (15.2) | 16 (4.4) | 7 (11.7) | 5 (8.3) | ||
T3/T4 | 56 (84.8) | 347 (95.6) | 53 (88.3) | 55 (91.7) | ||
Pathology N stage | 0.749 | 0.452 | ||||
N0 | 12 (18.2) | 73 (20.2) | 9 (15.0) | 13 (21.7) | ||
N1 | 29 (43.9) | 137 (37.7) | 26 (43.3) | 20 (33.3) | ||
N2 | 25 (37.9) | 153 (42.1) | 25 (41.7) | 27 (45.0) | ||
Segmental involvement | < 0.001 | 0.539 | ||||
1 | 15 (22.7) | 199 (54.8) | 15 (25.0) | 22 (36.7) | ||
2 | 21 (31.8) | 107 (29.5) | 20 (33.3) | 15 (25.0) | ||
3 | 9 (13.6) | 24 (6.6) | 8 (13.3) | 8 (13.3) | ||
≥4 | 21 (31.8) | 33 (9.1) | 17 (28.3) | 15 (25.0) | ||
Location of primary tumor | 0.225 | 0.367 | ||||
Right colon | 10 (15.2) | 89 (24.5) | 8 (13.3) | 14 (23.3) | ||
Left colon | 35 (53.0) | 180 (49.6) | 33 (55.0) | 29 (48.3) | ||
Rectum | 21 (31.8) | 94 (25.9) | 19 (31.7) | 17 (28.4) | ||
Size of primary tumor (cm) | 3.9 ± 2.0 | 5.4 ± 2.0 | < 0.001 | 4.0 ± 2.0 | 4.3 ± 2.1 | 0.660 |
Liver metastatic lesion size |
2.6 ± 1.9 | 2.5 ± 1.2 | 0.434 | 2.7 ± 2.0 | 2.4 ± 1.2 | 0.335 |
Variable | Before propensity score matching |
After propensity score matching |
||||
---|---|---|---|---|---|---|
NAC (+) (n=66) | NAC (–) (n=363) | P-value | NAC (+) (n=60) | NAC (–) (n=60) | P-value | |
Cycles of NAC | ||||||
Mean | 5 (2–8) | NA | NA | 5 (2–8) | NA | NA |
Total | ||||||
≤5 | 37 (56.1) | 33 (55.0) | ||||
>5 | 29 (43.9) | 27 (45.0) | ||||
NAC regimen | ||||||
FOLFOX | 7 (10.6) | 7 (11.7) | ||||
FOLFIRI | 34 (51.5) | 32 (53.3) | ||||
XELOX | 24 (36.4) | 20 (33.3) | ||||
XELIRI | 1 (1.5) | 1 (1.7) | ||||
NAC target agent | ||||||
(+) | 47 (71.2) | 45 (75.0) | ||||
(–) | 19 (28.8) | 15 (25.0) | ||||
NAC-operation interval (day) | 32 ± 12 | NA | NA | 33 ± 12 | NA | NA |
Adjuvant chemotherapy (+) | 58 (87.9) | 319 (87.9) | > 0.999 | 52 (86.7) | 45 (75.0) | 0.104 |
Adjuvant chemotherapy regimen | 0.003 | 0.555 | ||||
FOLFOX | 19 (32.8) | 87 (27.3) | 19 (36.5) | 12 (26.7) | ||
FOLFIRI | 17 (29.3) | 30 (9.4) | 12 (23.1) | 12 (26.7) | ||
XELOX | 20 (34.5) | 168 (52.7) | 19 (36.5) | 16 (35.6) | ||
XELIRI | 2 (3.4) | 25 (7.8) | 2 (3.9) | 4 (8.9) | ||
Others | 0 (0.0) | 9 (2.8) | 0 (0.0) | 1 (2.1) | ||
Target agent | < 0.001 | 0.083 | ||||
(+) | 22 (33.3) | 37 (10.2) | 16 (26.7) | 25 (41.7) | ||
(–) | 44 (66.7) | 326 (89.8) | 44 (73.3) | 35 (58.3) | ||
MSI | 0.019 | 0.555 | ||||
MSS | 61 (92.4) | 355 (97.9) | 55 (91.7) | 57 (95.0) | ||
MSI-H | 1 (1.5) | 2 (0.6) | 1 (1.7) | 0 (0) | ||
MSI-L | 4 (6.1) | 6 (1.5) | 4 (6.7) | 3 (5.0) | ||
KRAS | 0.768 | 0.648 | ||||
Wild type | 52 (78.8) | 280 (77.1) | 47 (78.3) | 49 (81.7) | ||
Mutation type | 14 (21.2) | 83 (22.9) | 13 (21.7) | 11 (18.3) |
Variable | Before propensity score matching |
After propensity score matching |
||||
---|---|---|---|---|---|---|
NAC (+) (n=66) | NAC (–) (n=363) | P-value | NAC (+) (n=60) | NAC (–) (n=60) | P-value | |
Hepatectomy | < 0.001 | 0.715 | ||||
Major |
36 (54.5) | 114 (31.4) | 32 (53.3) | 30 (50.0) | ||
Minor |
30 (45.5) | 249 (68.6) | 28 (46.7) | 30 (50.0) | ||
Primary tumor resection | 0.042 | 0.307 | ||||
RHC | 11 (16.7) | 88 (24.2) | 9 (15.0) | 11 (18.3) | ||
LHC | 0 (0) | 20 (5.5) | 0 (0) | 2 (3.3) | ||
AR/LAR/uLAR/ISR | 55 (83.3) | 255 (70.3) | 51 (85.0) | 47 (78.4) | ||
Surgical approach | 0.121 | 0.850 | ||||
Open | 42 (63.6) | 265 (73.0) | 38 (63.3) | 37 (61.7) | ||
MIS | 24 (36.4) | 98 (27.0) | 22 (36.7) | 23 (38.3) | ||
Stoma formation | 13 (19.7) | 44 (12.1) | 0.095 | 13 (21.7) | 6 (10.0) | 0.080 |
Variable | Before propensity score matching |
After propensity score matching |
||||
---|---|---|---|---|---|---|
NAC (+) (n=66) | NAC (–) (n=363) | P-value | NAC (+) (n=60) | NAC (–) (n=60) | P-value | |
Operation time (min) | 336 ± 112 | 297 ± 103 | 0.005 | 334 ± 112 | 312 ± 120 | 0.304 |
Transfusion | 10 (15.2) | 49 (13.5) | 0.720 | 9 (15.0) | 10 (16.7) | 0.803 |
Time to soft diet (day) | 2.9 ± 1.4 | 3.0 ± 1.2 | 0.852 | 2.8 ± 1.2 | 2.8 ± 1.0 | 0.869 |
Length of hospital stay (day) | 14±8 | 14±8 | 0.993 | 14±9 | 13±7 | 0.687 |
Postoperative mortality (< POD 30) |
0 (0) | 2 (0.6) | 0.546 | 0 (0) | 0 (0) | > 0.999 |
Postoperative morbidity | 24 (36.4) | 132 (36.4) | > 0.999 | 22 (36.7) | 23 (38.3) | 0.850 |
Bile leakage | 2 (3.0) | 9 (2.5) | 0.680 | 2 (3.3) | 4 (6.7) | 0.402 |
Surgical site infection | 9 (13.6) | 49 (13.5) | 0.976 | 8 (13.3) | 6 (10.0) | 0.570 |
Ileus | 7 (10.6) | 37 (10.2) | 0.919 | 5 (8.3) | 4 (6.7) | 0.729 |
Anastomotic leakage | 2 (3.0) | 19 (5.2) | 0.755 | 2 (3.3) | 3 (5.0) | 0.648 |
Intraabdominal fluid collection | 4 (6.1) | 21 (5.8) | 0.930 | 4 (6.7) | 4 (6.7) | > 0.999 |
Intraabdominal bleeding | 1 (1.5) | 5 (1.4) | 0.930 | 1 (1.7) | 2 (3.3) | 0.559 |
Variable | Before propensity score matching |
After propensity score matching |
||||
---|---|---|---|---|---|---|
NAC ≤ 4 (n = 28) | NAC > 5 (n = 38) | P-value | NAC ≤ 4 (n = 25) | NAC > 5 (n = 35) | P-value | |
Operation time (min) | 327 ± 113 | 342 ± 113 | 0.602 | 337 ± 114 | 332 ± 111 | 0.864 |
Transfusion | 7 (25.0) | 3 (7.9) | 0.055 | 6 (24.0) | 3 (8.6) | 0.099 |
Time to soft diet (day) | 3.2 ± 1.3 | 2.8 ± 1.4 | 0.222 | 2.9 ± 1.0 | 2.8 ± 1.4 | 0.650 |
Length of hospital stay (day) | 15 ± 11 | 13±6 | 0.274 | 14 ± 12 | 13±6 | 0.283 |
Postoperative mortality (< POD 30) | 0 (0) | 0 (0) | > 0.999 | 0 (0) | 0 (0) | > 0.999 |
Postoperative morbidity | 9 (32.1) | 15 (39.5) | 0.541 | 9 (36.0) | 13 (37.1) | 0.928 |
Bile leakage | 1 (3.6) | 1 (2.6) | 0.826 | 1 (4.0) | 1 (2.9) | 0.808 |
Surgical site infection | 3 (10.7) | 6 (15.8) | 0.722 | 3 (12.0) | 5 (14.3) | 0.797 |
Ileus | 1 (3.6) | 6 (15.8) | 0.111 | 1 (4.0) | 4 (11.4) | 0.305 |
Anastomotic leakage | 1 (3.6) | 1 (2.6) | 0.826 | 1 (4.0) | 1 (2.9) | 0.808 |
Intraabdominal fluid collection | 2 (7.1) | 2 (5.3) | 0.752 | 2 (8.0) | 2 (5.7) | 0.726 |
Intraabdominal bleeding | 0 (0) | 1 (2.6) | 0.387 | 0 (0) | 1 (2.9) | 0.394 |
Values are presented as mean±standard deviation or number (%). NAC, neoadjuvant chemotherapy; CEA, carcinoembryonic antigen; ASA, American Society of Anesthesiologists; PS, physical status. Largest size among metastatic lesions, which were measured from the resected specimen.
Values are presented as number (%) or mean±standard deviation if otherwise specified. NAC, neoadjuvant chemotherapy; NA, not applicable; FOLFOX, fluorouracil, leucovorin, oxaliplatin; FOLFIRI, fluorouracil, leucovorin, irinotecan; XELOX, capecitabine, oxaliplatin; XELIRI, capecitabine, irinotecan; MSI, microsatellite instability; MSS, microsatellite stable; MSI-H, MSI high; MSI-L, MSI low. Target agent: bevacizumab or cetuximab.
Values are presented as number (%). NAC, neoadjuvant chemotherapy; RHC, right hemicolectomy; LHC, left hemicolectomy; AR, anterior resection; LAR, low anterior resection; uLAR, ultra-low anterior resection, ISR, intersphincteric resection; MIS, minimal invasive surgery. RHC, extended RHC, LHC, and central hepatectomy. Left lateral sectionectomy, segmentectomy, non-anatomic resection.
Values are presented as mean±standard deviation or number (%). NAC, neoadjuvant chemotherapy; POD, postoperative day. Two patients died in the primary resection group because of (1) bowel ischemia and postoperative intraabdominal bleeding and (2) septic shock with anastomosis site leakage.
Values are presented as mean±standard deviation or number (%). NAC, neoadjuvant chemotherapy; POD, postoperative day.