Can Standard Surgical Procedure Reliably Be Avoided in Major Responders After Radio(chemo)therapy?
Pathological complete response (pCR) after radiochemotherapy (RCT) is increasingly reported with a range between 10% and 30%. Patients with pCR have favorable oncological outcome so that major surgery with total mesorectal excision (TME) is questionable and could be considered an overtreatment specially looking at the high rate of short- and long-term morbidity associated with this operation. “Wait and see” policy has been proposed by some authors in major responders as an alternative to radical resection. Nevertheless, clinical complete response (cCR) is a concept not easy to define, and it is not truly trustworthy in predicting pCR (25–85%) also using latest available imaging diagnostic techniques. Full-thickness local excision (LE) after RCT seems much more reliable and can be regarded as an optimal choice to achieve a definition of pathological response of primary tumor. The accuracy of LE in the definition of ypT is extremely high, and in ypT0, it is possible to predict, in a roundabout way, the absence of lymph node involvement with an accuracy of nearly 96%. Clinical trials to confirm validity of this less-invasive therapeutic approach are required.
KeywordsRectal Cancer Total Mesorectal Excision Local Excision Pathological Complete Response Transanal Endoscopic Microsurgery
Clinical complete response
Magnetic resonance imaging
Pathological complete response
Positron emission tomography
Transanal endoscopic microsurgery
Total mesorectal excision
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