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.
{"title":"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.","authors":"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","doi":"10.1016/j.ejca.2024.115156","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":11980,"journal":{"name":"European Journal of Cancer","volume":"216 ","pages":"115156"},"PeriodicalIF":7.6000,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Cancer","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ejca.2024.115156","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
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.
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.