Salvage Surgery With Organ Preservation for Patients With Local Regrowth After Watch and Wait: Is It Still Possible?

作者：Laura M. Fernández, Nuno L. Figueiredo, Angelita Habr‐Gama, Guilherme Pagin São Julião, Pedro Vieira, Bruna Borba Vailati, Irfan Ul Islam Nasir, Oriol Parés, Inês Santiago, Mireia Castillo-Martín, Carlos Carvalho, Amjad Parvaiz, Rodrigo Oliva Perez · 发表于：Diseases of the Colon & Rectum · 年份：2020 · 被引用次数：52 · 研究领域：Colorectal Cancer Surgical Treatments、Stoma care and complications、Reconstructive Surgery and Microvascular Techniques

BACKGROUND: Patients with rectal cancer who achieve complete clinical response after neoadjuvant chemoradiation have been managed nonoperatively. Thirty percent of these patients may develop a local regrowth, and salvage resection with radical surgery is usually recommended. However, selected patients could be offered additional organ preservation by local excision. We hypothesized that patients with baseline T2 who underwent neoadjuvant therapy (for the specific purpose of achieving a complete clinical response) were more likely to harbor recurrent disease at an earlier stage and amenable to organ preservation strategies (local excision) when compared with T3/T4 (undergoing neoadjuvant chemoradiation for oncologic reasons). OBJECTIVE: The purpose of this study was to compare patients with local regrowth requiring salvage resection according to their baseline stage. DESIGN: This was a retrospective review of consecutive patients with nonmetastatic distal rectal cancer undergoing neoadjuvant chemoradiation. SETTINGS: The study included 2 independent tertiary centers with institutional watch-and-wait organ preservation programs. PATIENTS: Consecutive patients with distal rectal cancer (cT2-4N1-2M0) managed by watch and wait and local regrowth from 2 institutions were included. MAIN OUTCOMES MEASURES: Final pathologic features and surgical and oncologic outcomes were compared according to baseline staging. RESULTS: A total of 73 of 257 patients experienced local regrowth. cT2 pr...