AI Article Synopsis
- The study evaluates long-term results and relapse risks in patients with mid-low rectal cancer (stages II and III) who were treated with transanal local excision following successful neoadjuvant chemoradiation.
- A small group of 32 out of 345 patients showed mostly clear surgical margins, with 28.1% experiencing relapse, primarily through local recurrences at the suture site.
- The findings suggest that the combined treatment approach is promising, especially for those categorized as ypT0/mic/1, but emphasizes the importance of carefully selecting patients to achieve the best outcomes.*
Article 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.
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| http://dx.doi.org/10.1002/jso.25794 | DOI Listing |
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