Locally advanced rectal cancer: Preliminary results of rectal preservation after neoadjuvant chemoradiotherapy
- Resource Type
- Authors
- Gustavo Rossi; Mabel Sardi; Carlos A. Vaccaro; Damián Beder; Joaquin Tognelli; Federico Julio Yazyi; Juan Pablo Santino; Fernando Bonadeo; José Lastiri; Guillermo Ojra Quintana
- Source
- Cirugia espanola. 94(5)
- Subject
- Male
medicine.medical_specialty
Colorectal cancer
medicine.medical_treatment
Rectum
Adenocarcinoma
Cohort Studies
03 medical and health sciences
0302 clinical medicine
medicine
Rectal Adenocarcinoma
Humans
Radical surgery
Neoadjuvant therapy
Aged
Neoplasm Staging
Retrospective Studies
business.industry
Rectal Neoplasms
Standard treatment
General Engineering
Chemoradiotherapy
Middle Aged
medicine.disease
Total mesorectal excision
Neoadjuvant Therapy
Surgery
medicine.anatomical_structure
Treatment Outcome
030220 oncology & carcinogenesis
030211 gastroenterology & hepatology
Female
business
Organ Sparing Treatments
- Language
- ISSN
- 1578-147X
Introduction The standard treatment for locally advanced rectal cancer is total mesorectal excision. However, organ preservation has been proposed for tumours with good response to neoadjuvant treatment. The aim of this study was to evaluate the oncologic results of this strategy. Methods This is a retrospective cohort study (2005–2014) including a consecutive series of patients with rectal adenocarcinoma with complete or almost complete clinical response after preoperative chemo-radiotherapy, that were treated according to a strategy of preservation of the rectum. Results A total of 204 patients with rectal cancer received neoadjuvant therapy. Thirty (14.7%) had a good response and were treated with rectal preservation (23 “Watch and wait” and 7 local resections). Median follow-up was 46 months (interquartile range: 30–68). In the group of “Watch & Wait”, 4 patients had local recurrence before 12 months (actuarial local recurrence rate=18.5%). All of them underwent salvage surgery (2 with radical surgery and 2 local resections) without any further recurrence. Disease-free survival actuarial rate at 3 years follow-up was 94.1% (95% CI 82.9–100). None of the 7 patients that were treated by local excision had local recurrence. The organ preservation rate for the whole group was 93%. Conclusion The strategy of organ preservation in locally advanced rectal cancer is feasible in cases with good response to neoadjuvant therapy. When implemented in a highly selected group of patients this strategy is associated with satisfactory oncologic results.