Oncologic Outcomes according to the Treatment Strategy in Radiologic Complete Responders after Neoadjuvant Chemoradiation for Rectal Cancer.

This study aimed to compare the oncologic outcomes between treatment strategies for rectal cancer [radical surgery, local excision (LE), and the wait-and-see approach] in radiologic complete responders after neoadjuvant chemoradiation (nCRT). We retrospectively reviewed rectal cancer patients and included 52 radiologic complete responders after nCRT defined as no residual tumor or residual fibrosis and no suspicious metastatic lymph nodes on magnetic resonance imaging (MRI). Clinicopathologic features and oncologic outcomes were compared according to the treatment strategies. The median follow-up period was 41 months (range, 6-80). Twenty-eight patients underwent radical surgery, whereas 16 underwent LE, and 8 were closely monitored without initial surgery. The pathologic complete response rate was 40.9%. Patients who underwent radical surgery showed better prognosis compared to those who underwent LE or wait-and-see (3-year disease-free survival: radical surgery 85.0% vs. LE 62.5%, wait-and-see 75.0%, p = 0.019; 3-year local recurrence-free survival: radical surgery 96.4% vs. LE 67.0%, wait-and-see 75.0%, p = 0.009). After recurrence, patients who underwent salvage surgery showed a relatively good oncologic outcome. Pursuing LE or the wait-and-see approach instead of radical surgery in rectal cancer patients undergoing nCRT may bring about a detrimental oncologic outcome if clinical complete response is solely determined by MRI.

Lee SY ，Kim CH ，Kim YJ ，Kim HR ... -  《-》

Local excision of rectal cancer followed by radical surgery because of poor prognostic features does not compromise the long term oncologic outcome.

The outcome of patients undergoing full-thickness local excision (LE) of rectal cancers may be compromised if poor prognostic features are found in the LE specimen. Our aim was to evaluate the long-term results of radical surgery performed after LE because poor prognostic factors are identified. Patients with biopsy-proven rectal cancer who had undergone full-thickness LE followed by radical surgery because of a positive margin, T stage ≥3, lymphovascular invasion, poor differentiation or mucinous histology were identified from a prospective database. Their records were retrospectively reviewed and follow up was updated. Between 1995 and 2003, 17 patients underwent LE followed by radical surgery because of poor prognostic features. Combined chemotherapy and radiotherapy was given to 11 (65%) patients before radical surgery. Patients underwent radical surgery after a median of 14 (range: 0-40) weeks from LE. Nine underwent a low anterior resection and eight an abdominoperineal resection. At the time of radical surgery, residual disease was found in six (35%) patients (in lymph nodes in three; intramural in two; and both lymph nodes and intramural in one). Four of the patients with residual disease had undergone neoadjuvant therapy before radical surgery. The mean follow up was 110 (95% CI: 92-129) months. Recurrence-free survival at 10 years was 88%. There was no case of local recurrence, and two patients died of metastatic disease. In this series patients who underwent early radical surgery because of poor prognostic features found at LE had good overall and cancer-specific long-term survival. Even after neoadjuvant therapy, more than a third of patients had residual disease at the time of radical surgery. We therefore recommend radical surgery with neoadjuvant therapy when poor prognostic features are found at LE.

Gagliardi G ，Newton TR ，Bailey HR 《-》

Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: are we getting closer to anal cancer management?

Habr-Gama A ，Sabbaga J ，Gama-Rodrigues J ，São Julião GP ，Proscurshim I ，Bailão Aguilar P ，Nadalin W ，Perez RO ... -  《-》

[Rectum-preserving surgery after consolidation neoadjuvant therapy or totally neoadjuvant therapy for low rectal cancer: a preliminary report].

Huang Y ，Huang SH ，Chi P ，Wang XJ ，Lin HM ，Lu XR ，Ye DX ，Lin Y ，Deng Y ... -  《-》

Wait-and-see or radical surgery for rectal cancer patients with a clinical complete response after neoadjuvant chemoradiotherapy: a cohort study.

Li J ，Liu H ，Yin J ，Liu S ，Hu J ，Du F ，Yuan J ，Lv B ，Fan J ，Leng S ，Zhang X ... -  《-》