Abstract
PURPOSE: Prognostic significance of intraoperative staging by surgeons and its possible complementary role with the pathological stage for evaluating the prognosis of rectal cancer after preoperative chemoradiation (CRT) is unknown. The goal of this study is to evaluate the diagnostic accuracy and prognostic role of intraoperative surgical staging by surgeons in patients with rectal cancer after preoperative CRT. METHODS: A total of 267 consecutive patients with rectal cancer who underwent preoperative CRT and radical resection from December 2007 to March 2010 were retrospectively reviewed. Surgical staging was evaluated by determining its diagnostic accuracy and analyzing its prognostic significance. RESULTS: Sensitivity, specificity, positive predictive value, and negative predictive value of intraoperative diagnosis of good responders (ypT0-2) were 78, 67, 53, and 86 %, respectively. The overall accuracy of good responders by surgeons was 71 %. A multivariate analysis revealed that pretreatment N stage and maximal tumor diameter were independent predictors for accordance of surgical and pathological diagnoses in T staging. The 3-year disease-free survival rates of the patients with surgical T0, T1, T2, T3, and T4 were 100, 94, 85, 84, and 58 %, respectively, and 86, 81, and 67 % for patients with surgical N0, N1, and N2 disease, respectively (P < 0.001 and P = 0.022, respectively). On multivariate analysis, surgical T stage was an independent prognostic factor for both disease-free survival and local recurrence. CONCLUSION: Intraoperative surgical tumor staging by surgeons may be an important predictor of survival in patients with rectal cancer after preoperative CRT.