Angela Maurizi, MD1, Susanna Mazzocato, MD2, Francesco Falsetti, MD1, Giorgio Degano, MD1, Mario Masella, MD1, Roberto Campagnacci, MD, PhD1. 1General Surgery, ASUR Regione Marche, “Carlo Urbani” Hospital, Jesi, Italy, 2Department of General Surgery, Università Politecnica delle Marche, 60126 Ancona, Italy
INTRODUCTION: Currently, neoadjuvant chemo-radiotherapy (nCRT) followed by low anterior resection or abdominoperineal resection are the standard treatments for locally advanced rectal cancer. nCRT can improve resecability, achieve better sphincter preservation and reduce local recurrence. Although total mesorectal excision is the standard treatment for advanced rectal cancer, recent trends in minimally invasive treatments led to an increase in local excision or “watch and wait” in patients with an excellent response to nCRT. The purpose of this study, part of an ongoing research, is critically evaluating the feasibility of “non-operative treatment” for rectal cancer in a district hospital.
METHODS AND PROCEDURES: A total of 29 patients with rectal cancer, who where treated with nCRT from January to August 2017 at “Carlo Urbani” district Hospital in Jesi (Italy), were retrospectively reviewed. All patients had histologically-confirmed primary adenocarcinoma of the rectum located within 12 cm from the anal verge. The involved patients completed nCRT and had no recurrence disease, distant metastasis, synchronous malignancies. They were classified according to the Mandard’s Tumor Regression Grade (TRG) into two clusters: group A (TRG 1-3) and B (TRG 4-5).
RESULTS: The average age of people is 67.2 and 17 were male. Five patients underwent abdominoperineal resection and 76% fell within group A. Six patients had lymph nodes involved. Four patients suffered relevant complications, such as wound complication, anastomotic leak, operative reintervention and death. Univariate analysis showed that the main predictors of tumor regression were the absence of lymph-nodes involvement from initial imaging (p<0.05), normal initial carcinoembryonic antigen level (p<0.05) and tumor downstaging in imaging (p<0.05). In addition, most relevant complications occurred to elderly patients although they observed a good clinical response. Besides, 13% of patients were found to be complete pathologic responders upon examination of the surgical specimen.
CONCLUSIONS: The oncologic feasibility of non-operative management for the patients with complete clinical response after nCRT has been growing, but some studies have suggested lack of oncologic safety in these patients. The patients with a complete clinical response expect good survival, but they may still harbor residual disease. No consensus on “watch and wait” policy in the field of rectal cancer was obtained, yet. Our data did not entirely support this policy although it might be the best strategy, based on the predictors of tumor regression, to avoid the complications associated with surgery in elderly patients with significant medical comorbidities and fear of a permanent stoma.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86677
Program Number: P266
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster