Pathologic complete response is associated with decreased morbidity following rectal cancer resection

Joshua H. Wolf, Ya Ching Hung, Solange Cox, Blessing Aghedo, Arun Mavanur, Shane Svoboda, Christopher R. D'Adamo

Research output: Contribution to journalArticlepeer-review


Background: There are conflicting data regarding the relationship between pathologic complete response (pCR) and post-operative complications following rectal cancer resection. The objective of this study was to compare the rates of morbidity among pCR patients and non-pCR patients and to identify factors that predict pCR morbidity in a large national database. Methods: This is a retrospective study using American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) targeted proctectomy data (2016–18). Patients with neoadjuvant chemoradiation therapy followed by proctectomy were included, and divided into pCR and non-pCR groups according to final stage. The groups were compared with Student's t-test, Chi-squared or Fisher's exact test. Multivariate logistic regression models were constructed to estimate the association between pCR status and post-operative morbidity while adjusting for key covariates. Results: 244 pCR and 1656 non-pCR patients were included. pCR patients had higher body mass index (28.1 ± 6.2 vs. 29.1 ± 5.9 kg/m2; p = 0.01) and lower pre-operative stage (T stage, p = 0.03; N stage, p < 0.001). The groups were equivalent with respect to surgical approach, type of surgery, and operative time (p > 0.05). Post-operative complications in pCR patients were less frequent than in non-pCR patients (23.0% vs. 29.3%; p = 0.04). This association was robust to adjustment for confounders in logistic regression, as patients with pCR had decreased odds of post-operative morbidity (OR 0.66, CI [0.43, 0.96], p = 0.04). Conclusion: pCR is associated with fewer post-operative complications compared to non-pCR, suggesting that pCR is not a marker of severe pelvic fibrosis. This difference may be due to underlying tumor biology, and associated increased technical challenges resecting larger, non-responsive tumors.

Original languageEnglish (US)
Pages (from-to)390-394
Number of pages5
JournalAmerican journal of surgery
Issue number2
StatePublished - Aug 2021


  • Neoadjuvant chemoradiation
  • Pathologic complete response
  • Post-operative morbidity
  • Proctectomy
  • Rectal cancer

ASJC Scopus subject areas

  • Surgery


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