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.

Organ-saving surgery for rectal cancer after neoadjuvant chemoradiation. Analysis of failures and long-term results / Cosimelli, Maurizio; Ursi, Pietro; Mancini, Raffaello; Pattaro, Giada; Perri, Pasquale; Parrino, Chiara; De Peppo, Valerio; Diodoro, Maria Grazia; Balla, Andrea; Grazi, Gian Luca. - In: JOURNAL OF SURGICAL ONCOLOGY. - ISSN 0022-4790. - (2019). [10.1002/jso.25794]

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

Ursi, Pietro;Balla, Andrea
;
2019

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.
2019
neoadjuvant chemoradiation; organ-saving surgery; rectal cancer; transanal local excision
01 Pubblicazione su rivista::01a Articolo in rivista
Organ-saving surgery for rectal cancer after neoadjuvant chemoradiation. Analysis of failures and long-term results / Cosimelli, Maurizio; Ursi, Pietro; Mancini, Raffaello; Pattaro, Giada; Perri, Pasquale; Parrino, Chiara; De Peppo, Valerio; Diodoro, Maria Grazia; Balla, Andrea; Grazi, Gian Luca. - In: JOURNAL OF SURGICAL ONCOLOGY. - ISSN 0022-4790. - (2019). [10.1002/jso.25794]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1336881
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