Skip to main content

Advertisement

SpringerLink
Log in

Individual participant data pooled-analysis of risk factors for recurrence after neoadjuvant radiotherapy and transanal local excision of rectal cancer: the PARTTLE study

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

An organ-preserving strategy may be a valid alternative in the treatment of selected patients with rectal cancer after neoadjuvant radiotherapy. Preoperative assessment of the risk for tumor recurrence is a key component of surgical planning. The aim of the present study was to increase the current knowledge on the risk factors for tumor recurrence.

Methods

The present study included individual participant data of published studies on rectal cancer surgery. The literature was reviewed according to according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Individual Participant Data checklist (PRISMA-IPD) guidelines. Series of patients, whose data were collected prospectively, having neoadjuvant radiotherapy followed by transanal local excision for rectal cancer were reviewed. Three independent series of univariate/multivariate binary logistic regression models were estimated for the risk of local, systemic and overall recurrence, respectively.

Results

We identified 15 studies, and 7 centers provided individual data on 517 patients. The multivariate analysis showed higher local and overall recurrences for ypT3 stage (OR 4.79; 95% CI 2.25–10.16 and OR 6.43 95% CI 3.33–12.42), tumor size after radiotherapy > 10 mm (OR 5.86 95% CI 2.33–14.74 and OR 3.14 95% CI 1.68–5.87), and lack of combined chemotherapy (OR 3.68 95% CI 1.78–7.62 and OR 2.09 95% CI 1.10–3.97), while ypT3 was the only factor correlated with systemic recurrence (OR 5.93). The analysis of survival curves shows that the overall survival is associated with ypT and not with cT.

Conclusions

Local excision should be offered with caution after neoadjuvant chemoradiotherapy to selected patients with rectal cancers, who achieved a good response to neoadjuvant chemoradiotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

Data availability

The datasets analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Vennix S, Pelzers L, Bouvy N et al (2014) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 4:CD005200

    Google Scholar 

  2. Habr-Gama A, Sao Juliao GP, Perez RO (2015) Nonoperative management of rectal cancer: identifying the ideal patients. Hematol Oncol Clin N Am 29:135–151

    Article  Google Scholar 

  3. Smith FM, Waldron D, Winter DC (2010) Rectum-conserving surgery in the era of chemoradiotherapy. Br J Surg 97:1752–1764

    Article  CAS  Google Scholar 

  4. Stewart LA, Clarke M, Rovers M, PRISMA-IPD Development Group et al (2015) Preferred reporting items for systematic review and meta-analyses of individual participant data: the PRISMA-IPD statement. JAMA 313:1657–1665

    Article  Google Scholar 

  5. Agenzia Italia del Farmaco (2008) Linee guida per la classificazione e la conduzione degli studi osservazionali sui farmaci. Roma

  6. Development Core Team (2008) A language and environment for statistical computing. Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0. http://www.R-project.org. Accessed 1 Feb 2019

  7. Guerrieri M, Gesuita R, Ghiselli R et al (2014) Treatment of rectal cancer by transanal endoscopic microsurgery: experience with 425 patients. World J Gastroenterol 28(20):9556–9563

    Article  Google Scholar 

  8. Stipa F, Picchio M, Burza A et al (2014) Long-term outcome of local excision after preoperative chemoradiation for ypT0 rectal cancer. Dis Colon Rectum 57:1245–1252

    Article  Google Scholar 

  9. Coco C, Rizzo G, Mattana C et al (2013) Transanal endoscopic microsurgery after neoadjuvant radiochemotherapy for locally advanced extraperitoneal rectal cancer: short-term morbidity and functional outcome. Surg Endosc 27:2860–2867

    Article  CAS  Google Scholar 

  10. Arezzo A, Arolfo S, Allaix ME et al (2015) Results of neoadjuvant short-course radiation therapy followed by transanal endoscopic microsurgery for T1–T2 N0 extraperitoneal rectal cancer. Int J Radiat Oncol Biol Phys 92:299–306

    Article  Google Scholar 

  11. Restivo A, Zorcolo L, D’Alia G et al (2016) Risk of complications and long-term functional alterations after local excision of rectal tumors with transanal endoscopic microsurgery (TEM). Int J Colorectal Dis 31:257–266

    Article  Google Scholar 

  12. Bujko K, Richter P, Smith FM et al (2013) Preoperative radiotherapy and local excision of rectal cancer with immediate radical re-operation for poor responders: a prospective multicentre study. Radiother Oncol 106:198–205

    Article  Google Scholar 

  13. Perez RO, Habr-Gama A, Sao Juliao GP et al (2016) Transanal endoscopic microsurgery (TEM) following neoadjuvant chemoradiation for rectal cancer: outcomes of salvage resection for local recurrence. Ann Surg Oncol 23:1143–1148

    Article  Google Scholar 

  14. Lezoche E, Baldarelli M, Lezoche G et al (2012) Randomized clinical trial of endoluminal locoregional resection versus laparoscopic total mesorectal excision for T2 rectal cancer after neoadjuvant therapy. Br J Surg 99:1211–1218

    Article  CAS  Google Scholar 

  15. Garcia-Aguilar J, Renfro LA, Chow OS et al (2015) Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol 16:1537–1546

    Article  Google Scholar 

  16. Lezoche G, Baldarelli M, Guerrieri M et al (2008) A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 22:352–358

    Article  CAS  Google Scholar 

  17. Cutting JE, Hallam SE, Thomas MG, Messenger DE (2018) A systematic review of local excision followed by adjuvant therapy in early rectal cancer: are pT1 tumors the limit? Colorectal Dis 20:854–863

    Article  CAS  Google Scholar 

  18. Perez RO, Habr-Gama A, Sao Juliao GP et al (2011) Transanal endoscopic microsurgery for residual rectal cancer after neoadjuvant chemoradiation therapy is associated with significant immediate pain and hospital readmission rates. Dis Colon Rectum 54:545–551

    Article  Google Scholar 

  19. Marks JH, Valsdottir EB, DeNittis A et al (2009) Transanal endoscopic microsurgery for the treatment of rectal cancer: comparison of wound complication rates with and without neoadjuvant radiation therapy. Surg Endosc 23:1081–1087

    Article  Google Scholar 

  20. Rullier E, Rouanet P, Tuech JJ et al (2017) Organ preservation for rectal cancer (GRECCAR 2): a prospective, randomised, open-label, multicentre, phase 3 trial. Lancet 390:469–479

    Article  Google Scholar 

  21. Garcia-Aguilar J, Renfro LA, Chow OS et al (2015) Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol 16(15):1537–1546

    Article  Google Scholar 

  22. Pucciarelli S, De Paoli A, Guerrieri M et al (2013) Local excision after preoperative chemoradiotherapy for rectal cancer: results of a multicenter phase II clinical trial. Dis Colon Rectum 56(12):1349–1356

    Article  Google Scholar 

  23. Bach SP, Hill J, Monson JR et al (2009) A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg 96:280–290

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We wish to thank Nicoletta Colombi who helped us with search strategy and literature selection, without whose contribution this study would not have been possible.

Author information

Authors and Affiliations

  1. Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy

    A. Arezzo, G. Lo Secco, L. Esposito, M. Mistrangelo & M. Morino

  2. Department of Nuclear Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy

    R. Passera

  3. Department of General Surgery, Università Politecnica delle Marche, Ancona, Italy

    M. Guerrieri & M. Ortenzi

  4. Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland

    K. Bujko

  5. Colorectal Surgery Division, University of São Paulo School of Medicine, São Paulo, Brazil

    R. O. Perez & A. Habr-Gama

  6. Department of Surgery, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy

    F. Stipa & M. Picchio

  7. Department of Surgical Sciences, University of Cagliari, Cagliari, Italy

    A. Restivo & L. Zorcolo

  8. Department of Surgical Sciences, Catholic University of Sacred Heart, Rome, Italy

    C. Coco & G. Rizzo

Authors
  1. A. Arezzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Lo Secco
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Passera
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Esposito
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Guerrieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Ortenzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. K. Bujko
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. R. O. Perez
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Habr-Gama
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. F. Stipa
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M. Picchio
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. A. Restivo
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. L. Zorcolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. C. Coco
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. G. Rizzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. M. Mistrangelo
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. M. Morino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Arezzo.

Ethics declarations

Conflict of interest

The author(s) declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the patient included in the case report.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arezzo, A., Lo Secco, G., Passera, R. et al. Individual participant data pooled-analysis of risk factors for recurrence after neoadjuvant radiotherapy and transanal local excision of rectal cancer: the PARTTLE study. Tech Coloproctol 23, 831–842 (2019). https://doi.org/10.1007/s10151-019-02049-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-019-02049-z

Keywords

Search

Navigation