The impact of surgical diversion before neoadjuvant therapy for XXXX .

@entity5 @entity1 @entity137
Up-front fecal diversion can palliate emergent symptoms related to locally advanced @entity5 (LARC) allowing @entity1 to receive neoadjuvant chemoradiation therapy (nCRT). We analyzed outcomes of pretreatment-diverted LARC @entity1 relative to nondiverted @entity1 to define the impact of this management strategy. We retrospectively collected data on 103 LARC @entity1 treated with nCRT and surgery. Medical records were reviewed for @entity1 characteristics, staging, treatment plan, and outcomes. Thirteen LARC @entity1 underwent pretreatment diversion for urgent symptoms and 90 LARC @entity1 proceeded directly to nCRT. In all, 50 per cent of diverted @entity1 presented with T4 @entity5 compared with 14 per cent in the nondiverted @entity1 (P = 0.003). Diverted @entity1 experienced a delay in time-to-treatment initiation of 12 days, although this difference was not statistically significant. Similar rates of chemoradiation and surgical @entity137 were observed. Even though diverted @entity1 demonstrated less pathologic response to nCRT compared with nondiverted @entity1 (P = 0.04), there was no significant difference in overall survival. In conclusion, our study demonstrates the effectiveness of up-front fecal diversion at managing emergent obstructive symptoms related to advanced @entity5 without additional complications, allowing @entity1 to proceed with nCRT followed by radical surgery.
