Neoadjuvant Treatment in Upper Rectal Cancer Does Not Improve Oncologic Outcomes But Increases Postoperative Morbidity.

BACKGROUND/AIM: Neoadjuvant chemoradiation/radiation therapy in locally advanced (LA) upper rectal adenocarcinoma management remains unclear. The aim of this study was to compare outcomes between neoadjuvant chemoradiation therapy (CRT) and upfront surgery (US). PATIENTS AND METHODS: A total of 127 patients were retrospectively included from 5 centers (79 treated with US and 48 with CRT). CRT and US groups were compared in terms of postoperative complications and long-term oncological and functional results. RESULTS: Total mesorectal excision (TME) was more frequent in CRT (58% vs. 20% in US, p<0.001). CRT was associated with more overall and severe postoperative complications (60% vs. 30%, p<0.001 and 17% vs. 1%, p=0.002, respectively), and was the only risk factor [OR=18.8 (2.2-160.2), p=0.007]. Five-year overall survival and 5-year recurrence-free survival were similar between CRT and US (96% vs. 91% p=0.256 and 85.4% vs. 85%, p=0.495). The functional results were similar between the two groups. CONCLUSION: CRT did not improve long-term oncological outcomes in patients with LA upper rectal adenocarcinoma, but increased postoperative complications compared with US.

Long-term outcome and late complications of acetabular fracture.

The long-term functional results of acetabular fractures are assessed in terms of the corresponding criteria of Merle-D'Aubigné and Postel (pain, mobility, walking). Other essential criteria include the quality of reduction and the radiological appearance.The age of the patient, the type of fracture and, above all, the interval between the accident and the surgical treatment or reduction of the fracture must be counted among the decisive factors which influence the late effects of this injury. Whether or not reduction can correctly center the femoral head in the socket is of paramount importance, but postoperative infection or the development of a hematoma may also critically affect outcome. In addition to a report on the long-term results achieved at the Trauma Department of the University Hospital of Freiburg, Germany, the literature on the late complications of acetabular fracture is also reviewed.