Long-Term Outcomes of Local Excision Following Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer
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ORIGINAL ARTICLE – COLORECTAL CANCER
Long-Term Outcomes of Local Excision Following Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer Lucrezia D’Alimonte, MD1, Quoc Riccardo Bao, MD1, Gaya Spolverato, MD1, Giulia Capelli, MD1, Paola Del Bianco, MS2, Laura Albertoni, MD3, Antonino De Paoli, MD4, Mario Guerrieri, MD5, Giovanna Mantello, MD6, Maria Antonietta Gambacorta, MD7, Vincenzo Canzonieri, MD8, Vincenzo Valentini, MD7, Claudio Coco, MD9, and Salvatore Pucciarelli, MD1 1
Department of Surgical, Oncological, and Gastroenterological Sciences, First Surgical Clinic, University of Padua, Padua, Italy; 2Clinical Research Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy; 3Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy; 4Department of Radiation Oncology, National Cancer Institute, Aviano, Italy; 5General Surgery, Marche Polytechnic University, Ancona, Italy; 6 Department of Radiotherapy, State Hospital, Ancona, Italy; 7Department of Radiotherapy, Catholic University of Rome, Rome, Italy; 8Department of Pathology, National Cancer Institute, Aviano, Italy; 9Department of Surgical Sciences, Catholic University of Rome, Rome, Italy
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
Ó The Author(s) 2020 First Received: 2 July 2020 Accepted: 28 August 2020 G. Spolverato, MD e-mail: [email protected]
(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 permanen
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