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Local excision in rectal cancer patients with major or complete clinical response after neoadjuvant therapy: a case-matched study

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

To assess the long-term oncological outcomes in patients with locally advanced rectal cancer who underwent neoadjuvant therapy followed by local or total mesorectal excision.

Methods

Patients with locally advanced rectal adenocarcinoma who received neoadjuvant therapy from 2005 to 2017 were evaluated. Those with major or complete clinical response underwent a full-thickness local excision. Kaplan-Meier estimates were used to evaluate overall, disease-free, and local recurrence-free survival of patients who underwent local excision (LE group) and were compared with a matched cohort of patients who underwent total mesorectal excision (TME group).

Results

Among 252 patients who received neoadjuvant therapy for rectal cancer, 51 (20.2%) underwent a local excision. At a median follow-up of 61 months, patients who underwent local excision were stoma-free in 88.2% of cases and with rectum preserved in 78.5% of cases, respectively. The estimated 5-year local, disease-free, and overall survival was 91.8% vs 97.6% (95% CI: 79.5–96.8 vs 84.6–99.6), 86.7% vs 86.4% (95% CI: 72.5–93.9 vs 70.1–94.1), and 85% vs 90% (95% CI: 69.0–93.0% vs 75.3–96.2), in the study and matched control group, respectively. None of the differences was statistically significant.

Conclusions

One-fifth of patients with locally advanced rectal cancer are manageable with a rectum-sparing approach after neoadjuvant therapy. With this strategy, about 80% patients will have their rectum preserved and 90% will be without stoma at long term.

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Abbreviations

LARC:

locally advanced rectal cancer

LE:

local excision

TME:

total mesorectal excision

TEM:

transanal endoscopic microsurgery

nCRT:

neoadjuvant (chemo)radiotherapy

pCR:

pathologic complete response

cCR:

complete clinical response

mCR:

major clinical response

WW:

watch-and-wait

LR:

local recurrence

DR:

distant recurrence

LAR:

low anterior resection

APR:

abdominoperineal resection

QoL:

quality of life

MRI:

magnetic resonance imaging

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Authors and Affiliations

  1. 1st Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy

    M. Bushati, S. Pucciarelli, I. Maretto, P. Toppan, A. Perin, E. D. L. Urso, A. Bagatella & G. Spolverato

  2. Regional Health Service, Epidemiology Unit, Veneto Region, Padua, Italy

    N. Gennaro

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  1. M. Bushati
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  2. S. Pucciarelli
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  3. N. Gennaro
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  4. I. Maretto
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Correspondence to S. Pucciarelli.

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Bushati, M., Pucciarelli, S., Gennaro, N. et al. Local excision in rectal cancer patients with major or complete clinical response after neoadjuvant therapy: a case-matched study. Int J Colorectal Dis 34, 2129–2136 (2019). https://doi.org/10.1007/s00384-019-03420-0

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  • DOI: https://doi.org/10.1007/s00384-019-03420-0

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