A new treatment strategy for mid-low rectal cancer patients exhibiting a clinical complete or near-complete response to neoadjuvant chemoradiotherapy: Transanal endoscopic microsurgery ——A multicenter prospective case-control clinical trial by MONT-R

IF 7.6 1区医学 Q1 ONCOLOGY

European Journal of Cancer Pub Date : 2025-02-05 DOI:10.1016/j.ejca.2024.115156

Xiaoyuan Qiu , Jiaolin Zhou , Huizhong Qiu , Zhanlong Shen , Bin Wu , Wenzhuo Jia , Beizhan Niu , Fei Li , Hongwei Yao , Aiwen Wu , Ke Hu , Huadan Xue , Guangxi Zhong , Weixun Zhou , Weijie Chen , Ganbin Li , Guole Lin

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引用次数: 0

Abstract

Background

Total mesorectal excision is the standard surgery for locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (nCRT), but it may lead to high complication rates and poor quality of life. This study evaluates whether transanal endoscopic microsurgery (TEM), as a partial resection procedure, can enhance quality of life for clinical complete response (cCR) or near-cCR patients without compromising survival.

Methods

Between May 2017 to September 2021, 80 patients with T3–4N0M0 or TanyN+M0 mid-low rectal cancer achieving cCR or near-cCR post-nCRT were prospectively included at 6 Chinese centers. Patients underwent either TEM (Group A, n = 38) or radical surgery (Group B, n = 41). Clinicopathological, oncological, and functional outcomes were analyzed.

Results

Postoperative histology revealed 22 ypT0 (57.9 %), 5 ypT1 (13.2 %), 10 ypT2 (26.3 %), and 1 ypT3 (2.6 %) cases in group A and 20 pCR (48.8 %), 1 T0N1 (2.4 %), 5 T1N0 (12.2 %), 12 T2–3N0 (29.3 %), 3 T2–3N1 (7.3 %) cases in group B. After a 60-month median follow-up, local recurrence occurred in 2 patients (5.26 %) in Group A and none in Group B. Distant metastases occurred in 8 patients (21.05 %) in group A and 7 (17.07 %) in group B. There was no significant difference between the two groups in 5-year disease-free survival (P = 0.658) or 5-year overall survival (P = 0.465). Group A showed significantly faster recovery (P < 0.001) and better sphincter function per Wexner (1 vs. 4, P = 0.001) and LARS (0 vs. 17, P < 0.001) scores than Group B.

Conclusion

TEM may be an effective approach for assessing residual tumors in LARC patients with cCR or near-cCR. This approach offers an option for those requiring sphincter preservation, with no significant compromise in long-term oncological outcomes observed in our study.

查看原文本刊更多论文

对新辅助放化疗有临床完全或接近完全反应的中低位直肠癌患者的新治疗策略：经肛门内镜显微手术——由MONT-R进行的一项多中心前瞻性病例对照临床试验。

背景：全肠系膜切除是局部晚期直肠癌（LARC）新辅助放化疗（nCRT）后的标准手术，但其并发症发生率高，生活质量差。本研究评估经肛门内窥镜显微手术（TEM）作为部分切除手术是否可以提高临床完全缓解（cCR）或接近cCR患者的生活质量而不影响生存。方法：2017年5月至2021年9月，在中国6个中心前瞻性纳入80例在ncrt后达到cCR或接近cCR的T3-4N0M0或TanyN+M0中低位直肠癌患者。患者接受TEM （A组，n = 38）或根治性手术（B组，n = 41）。分析临床病理、肿瘤和功能结果。结果:术后组织学：A组ypT0 22例（57.9%）、ypT1 5例（13.2%）、ypT2 10例（26.3%）、ypT3 1例（2.6%）；b组pCR 20例（48.8%）、T0N1 1例（2.4%）、T1N0 5例（12.2%）、T2-3N0 12例（29.3%）、T2-3N1 3例（7.3%）。A组局部复发2例（5.26%），b组无复发。A组远处转移8例（21.05%），b组远处转移7例（17.07%）。两组5年无病生存率（P = 0.658）和5年总生存率（P = 0.465）差异无统计学意义。结论：透射电镜可能是评估LARC合并cCR或近cCR患者残余肿瘤的有效方法。该方法为需要保留括约肌的患者提供了一种选择，在我们的研究中没有观察到长期肿瘤预后的显著妥协。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Cancer 医学-肿瘤学

CiteScore

11.50

自引率

4.80%

发文量

953

审稿时长

23 days

期刊介绍： The European Journal of Cancer (EJC) serves as a comprehensive platform integrating preclinical, digital, translational, and clinical research across the spectrum of cancer. From epidemiology, carcinogenesis, and biology to groundbreaking innovations in cancer treatment and patient care, the journal covers a wide array of topics. We publish original research, reviews, previews, editorial comments, and correspondence, fostering dialogue and advancement in the fight against cancer. Join us in our mission to drive progress and improve outcomes in cancer research and patient care.