Completion total mesorectal excision after neoadjuvant radiochemotherapy and local excision for rectal cancer

• DOI: 10.1111/codi.16834
• Publication Date: 2023-12-22T13:14:57Z
• Authors: Claudio Coco; Paolo Delrio; Daniela Rega; Luca Emanuele Amodio; Salvatore Pucciar...; Gaya Spolverato; Claudio Belluco; Andrea Lauretta; Gilberto Poggioli; Giuseppe Rocco; Francesco Bianco; Patrizia Marsanic; Giuseppe Sica; Vincenzo Tondolo; Gianluca Rizzo
• Keywords: Neoadjuvant Therapy; Stoma (medicine)

Abstract Aim Local excision (LE) in selected cases after neoadjuvant radiochemotherapy (RCT) for locally advanced rectal cancer clinically complete or major responders has been recently reported as an alternative to standard radical resection. Completion total mesorectal (cTME) is generally performed when high‐risk pathological features are found LE surgical specimens. The aim of this study was evaluate the incidence residual tumour and lymph node metastases cTME patients previously treated by RCT + LE. secondary aims were quantify rate postoperative morbidity mortality long‐term oncological outcome group patients. Methods All from 2007 2020 with a response who had subsequent factors (ypT >1 and/or TRG >2 positive margins) included multicentre retrospective study. Pathological data, short‐term (classified according Clavien–Dindo) recorded database. Statistical analysis using Wizard iOS version 1.9.31. Results A 47 R0 resection 95.7%, sphincter‐saving procedure 37 (78.7%), protective stoma 78.4%. In 28 (59.6%), it possible perform minimally invasive approach. (pT pN) on specimens 21 (44.7%). 12.8%. overall (within 30 days) 34%, but grade complications occurred only nine (19.1%), reoperation 6.4%. No deaths occurred. At median follow‐up 57 months (range: 21–174), stoma‐free 70.2%, actuarial 5‐year survival (OS), disease‐free (DFS) local control (LC) 86.7%, 88.9% respectively. Conclusion When exhibit LE, should be suggested due high risk involvement results terms resection, procedure, seem acceptable do not represent contraindication use first‐step treatment clinical RCT.