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Organ‐saving surgery for rectal cancer after neoadjuvant chemoradiation: Analysis of failures and long‐term results
Author(s) -
Cosimelli Maurizio,
Ursi Pietro,
Mancini Raffaello,
Pattaro Giada,
Perri Pasquale,
Parrino Chiara,
De Peppo Valerio,
Diodoro Maria Grazia,
Balla Andrea,
Grazi Gian Luca
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25794
Subject(s) - medicine , total mesorectal excision , colorectal cancer , surgery , radical surgery , chemoradiotherapy , adenocarcinoma , radiation therapy , cancer
Background To analyze long‐term results and risk of relapse in the clinical TNM stages II and III, mid‐low rectal cancer patients (RC pts), treated with transanal local excision (LE) after major response to neoadjuvant chemoradiation (n‐CRT). Methods Thirty‐two out of 345 extraperitoneal cT3–4 or N+ RC pts (9.3%) underwent LE. Inclusion criteria: extraperitoneal RC, adenocarcinoma, ECOG Performance Status ≤2. Pts with distant metastases were excluded. Results All pts showed histologically clear margins of resection and 81.2% were restaged ypT0/mic/1. Nine out of 32 (28.1%) pts relapsed: 7 (21.8%) showed a local recurrence, of which 5 (15.6%) at the endorectal suture, 1 (3.1%) pelvic and 1 (3.1%) mesorectal. Two pts (6.2%) relapsed distantly. Among the pT0/1, 11.5% relapsed vs 100% of the pT2 and pT4 ones. The six pts relapsing locally or in the mesorectal fat underwent a salvage total mesorectal excision surgery. The old patient with pelvic recurrence relapsed after 108 months and underwent a re‐irradiation; the two pts with distant metastases were treated with chemotherapy followed by radical surgery. Conclusions Presently combined approach seems a valid option in major responders, confirming its potential curative impact in the ypT0/mic/1 pts. A strict selection of pts is basic to obtain favourable results.