Feasibility of a tailored operative strategy from organ preservation to pelvic exenteration for cT4 rectal cancer depending on neoadjuvant response.

IF 2.5 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Christina Fleming, Deena Harji, Benjamin Fernandez, Marc-Olivier François, Vincent Assenat, Pasticier Gilles, Michiels Clément, Grégoire Robert, Quentin Denost
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Abstract

Purpose: Improvements in neoadjuvant therapy for locally advanced cT4 rectal cancer have led to improved tumour response and thus a variety of suitable management strategies. The aim of this study was to report management and outcomes of patients with cT4 rectal cancer undergoing a spectrum of treatment strategies from organ preservation (OP) to pelvic exenteration (PE).

Methods: Patients who underwent elective treatment for cT4 rectal cancer between 2016 and 2021 were included. All patients were treated with curative intent. Surgical management was adapted to tumour response. Kaplan-Meier curves were generated to compare 3-year overall survival (3y-OS), local recurrence (3y-LR) and distant metastases (3y-DM) between different strategies.

Results: Among 152 patients included, 13 (8%) underwent OP, 71 (47%) TME and 68 (45%) APR/PE. The median follow-up was 31.3 months. Patients undergoing OP had a lower tumour pretreatment (p < 0.001). Compared to patients with TME, those with APR/PE had a higher rate of ypT4 (p = 0.001) with a lower R0 rate (p = 0.044). The 3y-OS and 3y-DM were 78% and 15.1%, respectively, without significant differences. The 3y-LR was 6.6%, and patients with OP had a significantly worse 3y-local regrowth compared to 3y-LR in patients with TME and APR/PE (30.2% vs. 5.4% vs. 2%, p = 0.008).

Conclusion: cT4 tumours may be suitable for the full spectrum of rectal cancer management from organ preservation to pelvic exenteration depending on tumour response to neoadjuvant therapy. However, careful attention is required in OP as local regrowth in up to 30% of cases reinforces the need for sustained active surveillance in Watch&Wait programmes.

Abstract Image

根据新辅助治疗反应,为cT4直肠癌量身定制从保留器官到骨盆外扩的手术策略的可行性。
目的:局部晚期 cT4 直肠癌新辅助疗法的改进改善了肿瘤反应,因此出现了多种合适的治疗策略。本研究旨在报告接受从器官保留(OP)到骨盆外展(PE)等一系列治疗策略的cT4直肠癌患者的管理和预后情况:方法:纳入2016年至2021年间接受cT4直肠癌择期治疗的患者。所有患者均接受了治愈性治疗。手术治疗根据肿瘤反应进行调整。生成卡普兰-梅耶曲线,比较不同策略的3年总生存率(3y-OS)、局部复发率(3y-LR)和远处转移率(3y-DM):在纳入的 152 例患者中,13 例(8%)接受了 OP,71 例(47%)接受了 TME,68 例(45%)接受了 APR/PE。中位随访时间为 31.3 个月。接受 OP 的患者肿瘤治疗前(p)较低 结论:根据肿瘤对新辅助治疗的反应,cT4 肿瘤可能适合接受从器官保留到骨盆外扩的全方位直肠癌治疗。然而,由于高达 30% 的病例会出现局部再生,因此需要在观察和等待计划中进行持续的主动监测,这一点在 OP 中需要谨慎注意。
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来源期刊
CiteScore
4.90
自引率
3.60%
发文量
206
审稿时长
3-8 weeks
期刊介绍: The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.
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