Locally advanced rectal cancer: Preliminary results of rectal preservation after neoadjuvant chemoradiotherapy. / Cáncer de recto localmente avanzado: resultados preliminares de la preservación del recto después de quimiorradioterapia neoadyuvante.

INTRODUCTION: The standard treatment for locally advanced rectal cancer is total mesorectal excision. However, organ preservation has been proposed for tumors with good response to neoadjuvant treatment. The aim of this study was to evaluate the oncologic results of this strategy. METHODS: This is a retrospective cohort study (2005-2014) including a consecutive series of patients with rectal adenocarcinoma with complete or almost complete clinical response after preoperative chemo-radiotherapy, that were treated according to a strategy of preservation of the rectum. RESULTS: A total of 204 patients with rectal cancer received neoadjuvant therapy. Thirty (14.7%) had a good response and were treated with rectal preservation (23 «Watch and Wait¼ and 7 local resections). Median follow-up was 46 months (interquartile range: 30-68). In the group of «Watch & Wait¼, 4 patients had local recurrence before 12 months (actuarial local recurrence rate=18.5%). All of them underwent salvage surgery (2 with radical surgery and 2 local resections) without any further recurrence. Disease-free survival actuarial rate at 3 years follow-up was 94.1% (95% CI 82.9-100). None of the 7 patients that were treated by local excision had local recurrence. The organ preservation rate for the whole group was 93%. CONCLUSION: The strategy of organ preservation in locally advanced rectal cancer is feasible in cases with good response to neoadjuvant therapy. When implemented in a highly selected group of patients this strategy is associated with satisfactory oncologic results.

Cáncer de recto localmente avanzado: resultados preliminares de la preservación del recto después de quimiorradioterapia neoadyuvante / Locally advanced rectal cancer: Preliminary results of rectal preservation after neoadjuvant chemoradiotherapy

Introducción: El estándar de tratamiento del cáncer de recto localmente avanzado es la escisión total del mesorrecto. Sin embargo, la preservación del órgano ha sido propuesta para los tumores con buena respuesta al tratamiento neoadyuvante. El objetivo de este estudio es investigar los resultados oncológicos de esta estrategia. Métodos: Se realizó un estudio de cohorte retrospectivo, en el que se analizó a los pacientes con adenocarcinoma de recto tratados con intención curativa entre 2005 y 2014 que, después de recibir quimiorradioterapia neoadyuvante, presentaron una respuesta clínica completa o casi completa y fueron tratados con preservación del recto. Resultados: Durante el periodo de estudio, 204 pacientes con cáncer del recto recibieron neoadyuvancia. Treinta (14,7%) presentaron una respuesta clínica completa o casi completa y se trataron según una estrategia de preservación de órgano (23 watch & wait y 7 resecciones locales). La mediana de seguimiento fue de 46 meses (rango intercuartil: 30-68). En el grupo de watch & wait, 4 casos presentaron recurrencia local antes del año (tasa actuarial 18,5%). Todos pudieron ser rescatados (2 con cirugía radical y 2 con resecciones locales) sin presentar nuevas recurrencias. El índice de supervivencia libre de enfermedad a distancia a 3 años fue de 94,1% (IC 95%: 82,9-100). De los 7 casos que se trataron mediante resección local, ninguno presentó recurrencia local. Considerando toda la muestra, la proporción de conservación de órgano fue del 93%. Conclusiones: La estrategia de preservación de órgano en el cáncer rectal localmente avanzado es factible en casos con buena respuesta a la neoadyuvancia. Implementada en un grupo altamente seleccionado de pacientes, se asocia con resultados oncológicos satisfactorios (AU)

Introduction: The standard treatment for locally advanced rectal cancer is total mesorectal excision. However, organ preservation has been proposed for tumors with good response to neoadjuvant treatment. The aim of this study was to evaluate the oncologic results of this strategy. Methods: This is a retrospective cohort study (2005-2014) including a consecutive series of patients with rectal adenocarcinoma with complete or almost complete clinical response after preoperative chemo-radiotherapy, that were treated according to a strategy of preservation of the rectum. Results: A total of 204 patients with rectal cancer received neoadjuvant therapy. Thirty (14.7%) had a good response and were treated with rectal preservation (23 «Watch and Wait» and 7 local resections). Median follow-up was 46 months (interquartile range: 30-68). In the group of «Watch & Wait», 4 patients had local recurrence before 12 months (actuarial local recurrence rate = 18.5%). All of them underwent salvage surgery (2 with radical surgery and 2 local resections) without any further recurrence. Disease-free survival actuarial rate at 3 years follow-up was 94.1% (95% CI 82.9-100). None of the 7 patients that were treated by local excision had local recurrence. The organ preservation rate for the whole group was 93%. Conclusion: The strategy of organ preservation in locally advanced rectal cancer is feasible in cases with good response to neoadjuvant therapy. When implemented in a highly selected group of patients this strategy is associated with satisfactory oncologic results (AU)