Long-Term Outcomes of Local Excision Following Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer

L. D'Alimonte, Q. R. Bao, G. Spolverato*, G. Capelli, Bianco P. Del, L. Albertoni, Paoli A. De, M. Guerrieri, G. Mantello, Maria Antonietta Gambacorta, V. Canzonieri, V. Valentini, Claudio Coco, S. Pucciarelli

*Autore corrispondente per questo lavoro

Risultato della ricerca: Contributo in rivistaArticolo

Abstract

Background: Local excision might represent an alternative to total mesorectal excision for patients with locally advanced rectal cancer who achieve a major or complete clinical response after neoadjuvant chemoradiotherapy. Methods: Between August 2005 and July 2011, 63 patients with mid-low rectal adenocarcinoma who had a major/complete clinical response after neoadjuvant chemoradiotherapy were enrolled in a multicenter prospective phase 2 trial and underwent transanal full thickness local excision. The main endpoint of this study was to evaluate the 5- and 10-year overall, relapse-free, local, and distant relapse-free survival, which were calculated by applying the Kaplan–Meier method. The rate of patients with rectum preserved and without stoma were also calculated. Results: Of 63 patients, 38 (60%) were male and 25 (40%) were female, with a median (range) age of 64 (25–82) years. At baseline, the following clinical stages were found: cT2, n = 21 (33.3%); cT3, n = 42 (66.6%), 39 (61.9%) patients were cN+. At a median (range) follow-up of 108 (32–166) months, the estimated cumulative 5- and 10-year overall survival, relapse-free survival, local recurrence-free survival, and distant recurrence-free survival were 87% (95% CI 76–93) and 79% (95% CI 66–87), 89% (95% CI 78–94) and 82% (95% CI 66–91), both 91% (95% CI 81–96), and 90% (95% CI 80–95) and 86% (95% CI 73–93), respectively. Overall, 49 (77.8%) patients had their rectum preserved, and 54 (84.1%) were stoma-free. Conclusion: In highly selected patients, the local excision approach after neoadjuvant chemoradiotherapy is associated with excellent long-term outcomes, high rates of rectum preservation and absence of permanent stoma.
Lingua originaleInglese
pagine (da-a)2801-2808
Numero di pagine8
RivistaAnnals of Surgical Oncology
Volume28
Numero di pubblicazione5
DOI
Stato di pubblicazionePubblicato - 2021

All Science Journal Classification (ASJC) codes

  • Chirurgia
  • Oncologia

Keywords

  • 80 and over
  • Aged
  • Chemoradiotherapy
  • Disease-Free Survival
  • Female
  • Humans
  • Local
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Neoplasm Recurrence
  • Neoplasm Staging
  • Prospective Studies
  • Rectal Neoplasms
  • Rectum
  • Treatment Outcome

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