医学
全直肠系膜切除术
结直肠癌
直肠
新辅助治疗
外科肿瘤学
放化疗
外科
临床试验
入射(几何)
前瞻性队列研究
内科学
放射治疗
肿瘤科
癌症
物理
乳腺癌
光学
作者
Francesco Marchegiani,Valeria Palatucci,Giulia Capelli,Mario Guerrieri,Claudio Belluco,Daniela Rega,Emilio Morpurgo,Claudio Coco,Angelo Restivo,Silvia De Franciscis,C. Aschele,Alessandra Perin,Michele Bonomo,Andrea Muratore,Antonino Spinelli,Salvatore Ramuscello,Francesca Bergamo,Giampaolo Montesi,Gaya Spolverato,Paola Del Bianco,Maria Antonietta Gambacorta,Paolo Delrio,Salvatore Pucciarelli
标识
DOI:10.1245/s10434-021-11121-8
摘要
Rectum-preservation for locally advanced rectal cancer has been proposed as an alternative to total mesorectal excision (TME) in patients with major (mCR) or complete clinical response (cCR) after neoadjuvant therapy. The purpose of this study was to report on the short-term outcomes of ReSARCh (Rectal Sparing Approach after preoperative Radio- and/or Chemotherapy) trial, which is a prospective, multicenter, observational trial that investigated the role of transanal local excision (LE) and watch-and-wait (WW) as integrated approaches after neoadjuvant therapy for rectal cancer.Patients with mid-low rectal cancer who achieved mCR or cCR after neoadjuvant therapy and were fit for major surgery were enrolled. Clinical response was evaluated at 8 and 12 weeks after completion of chemoradiotherapy. Treatment approach, incidence, and reasons for subsequent TME were recorded.From 2016 to 2019, 160 patients were enrolled; mCR or cCR at 12 weeks was achieved in 64 and 96 of patients, respectively. Overall, 98 patients were managed with LE and 62 with WW. In the LE group, Clavien-Dindo 3+ complications occurred in three patients. The rate of cCR increased from 8- to 12-week restaging. Thirty-three (94.3%) of 35 patients with cCR had ypT0-1 tumor. At a median 24 months follow-up, a tumor regrowth was found in 15 (24.2%) patients undergoing WW.LE for patients achieving cCR or mCR is safe. A 12-week interval from chemoradiotherapy completion to LE is correlated with an increased cCR rate. The risk of ypT > is reduced when LE is performed after cCR.
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