Organ-saving surgery for rectal cancer after neoadjuvant chemoradiation: Analysis of failures and long-term results

Maurizio Cosimelli, Pietro Ursi, Raffaello Mancini, Giada Pattaro, Pasquale Perri, Chiara Parrino, Valerio De Peppo, Maria Grazia Diodoro, Andrea Balla, Gian Luca Grazi

Research output: Contribution to journalArticle

Abstract

Background: To analyze long-term results and risk of relapse in the clinical TNM stages II and III, mid-low rectal cancer patients (RC pts), treated with transanal local excision (LE) after major response to neoadjuvant chemoradiation (n-CRT). Methods: Thirty-two out of 345 extraperitoneal cT3–4 or N+ RC pts (9.3%) underwent LE. Inclusion criteria: extraperitoneal RC, adenocarcinoma, ECOG Performance Status ≤2. Pts with distant metastases were excluded. Results: All pts showed histologically clear margins of resection and 81.2% were restaged ypT0/mic/1. Nine out of 32 (28.1%) pts relapsed: 7 (21.8%) showed a local recurrence, of which 5 (15.6%) at the endorectal suture, 1 (3.1%) pelvic and 1 (3.1%) mesorectal. Two pts (6.2%) relapsed distantly. Among the pT0/1, 11.5% relapsed vs 100% of the pT2 and pT4 ones. The six pts relapsing locally or in the mesorectal fat underwent a salvage total mesorectal excision surgery. The old patient with pelvic recurrence relapsed after 108 months and underwent a re-irradiation; the two pts with distant metastases were treated with chemotherapy followed by radical surgery. Conclusions: Presently combined approach seems a valid option in major responders, confirming its potential curative impact in the ypT0/mic/1 pts. A strict selection of pts is basic to obtain favourable results.

Original languageEnglish
JournalJournal of Surgical Oncology
DOIs
Publication statusAccepted/In press - Jan 1 2019

Keywords

  • neoadjuvant chemoradiation
  • organ-saving surgery
  • rectal cancer
  • transanal local excision

ASJC Scopus subject areas

  • Surgery
  • Oncology

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