Locally advanced rectal cancer: Preliminary results of organ preservation after neoadjuvant chemo-radiotherapy

CARLOS A. VACCARO; FEDERICO JULIO YAZYI; GUILLERMO OJEA QUINTANA; JUAN PABLO SANTINO; MABEL EDITH SARDI; DAMIÁN BEDER; JOAQUIN TOGNELLI; FERNANDO BONADEO; JOSÉ MARÍA LASTIRI; GUSTAVO LEANDRO ROSSI

CIRUGIA ESPANOLA

ELSEVIER DOYMA SL

Lugar: Madrid; Año: 2015

0009-739X

INTRODUCTION:The standard treatment for locally advanced rectal cancer is total mesorectal excision. However, organ preservation has been proposed for tumors 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.Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.KEYWORDS:Complete clinical response; Conservative treatment; Cáncer de recto; Local resection; Neoadjuvant; Neoadyuvancia; Rectal cancer; Resección local; Respuesta clínica completa; Tratamiento conservador; Watch and wait; «Watch and wait»