Chapter 3 46 was not reached for patients with an R0 resection (3-year LRFS 72 percent), andmedian LRFS was 10 months after an R+ resection. Median MFS was 8 months irrespective of response to treatment or resection margin. Figure 2. Significant linear relation between increasing Mandard score and probability of a positive resection margin. responders was not reached (3-year MFS 75%): 45 months for good responders, and 11 months for poor responders (Fig. 1a, b). For all oncological outcome parameters, both response and complete resection were the most independent predictive variables. By definition, all complete responders have an R0 resection. However, there also is a linear relation between increasing response and the rate of R0 resections (p = 0.026, Fig. 2). Therefore, both variables were combined to see whether outcome prediction can be fine-tuned and may help to make treatment decisions. Five new categories were analyzed: pCR (automatically R0), good response and R0 resection, poor response and R0 resection, good response and R1/R2 (R?) resection, and finally, poor response and R? resection. In Fig. 1c, the outcome of combining these variables is shown. Complete responders consistently demonstrate an excellent outcome 23 months aft not reached fo 72%), and m resection. Me response to tre Toxicity and C Data on to were available was observed toxicity was s were available was reported i toxicity was s Postoperativ ileus/gastropar (n = 21), pneu urinary tract (n = 13). Ma Dindo C3) w There was no within 30 days In the 41 patie there were 46 which 34 com 10 required an required ICU shown in Tabl DISCUSSION In this stud 1 2 3 4 5 Mandard score 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% R0 R1 or R2 100 76.19 54.72 45.16 40 23.81 45.28 54.84 60 FIG. 2 Significant linear relation between increasing Mandard score and probability of a positive resection margin. R0 resection with clear margins; R1/2 resection with involved margins R0 resection with clear margins; R1/2 resection with involved margins Toxicity and complications Data on toxicity caused by induction chemotherapy were available for 125 of 132 patients. Grade 3–4 toxicity was observed in 12 of 125 patients (10 percent). No grade 5 toxicity was seen. Details on chemoradiotherapy toxicity were available for 121 of 132 patients. Grade 3–4 toxicity was reported in only 2 of 121 patients (2 percent), and no grade 5 toxicity was seen. Postoperatively, the most common complications were ileus/gastroparesis (n = 31), urological complications (n=21), pneumonia (n= 19), presacral abscess (n= 17), urinary tract infection ( = 14), andwound infection (n= 13). Major postoperative complications (Clavien Dindo C 3) er observed in 41 of 132 patients (31 perc nt). There was no inhospital mortality, but one patient diedwithin 30 days of surgery as she refused further treatment. In the 41 patients with major postoperative complications, there were 46 complications with a Clavien Dindo C 3 of which 34 complications required a surgical reintervention, 10 required an endoscopic/radiological intervention, and 3 required ICU admittance. The type of complications are shown in Table 4.