Failure to rescue following proctectomy for rectal cancer: the additional benefit of laparoscopic approach in a nationwide observational study of 44,536 patients

2021 ◽  
Author(s):  
Mehdi El Amrani ◽  
Guillaume Clement ◽  
Xavier Lenne ◽  
Anthony Turpin ◽  
Caroline Valibouze ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Observational Study ◽  
Laparoscopic Approach ◽  
Additional Benefit ◽  
Failure To Rescue ◽  
Nationwide Observational Study

scholarly journals Multimodal Treatment of cT3 Rectal Cancer in a Prospective Multi-Center Observational Study: Can Neoadjuvant Chemoradiation Be Omitted in Patients with an MRI-Assessed, Negative Circumferential Resection Margin?

2021 ◽  
pp. 1-8
Author(s):  
Henry Ptok ◽  
Frank Meyer ◽  
Ingo Gastinger ◽  
Benjamin Garlipp
Keyword(s):  
Rectal Cancer ◽  
Observational Study ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Anal Verge ◽  
Final Analysis ◽  
Radical Resection ◽  
Distant Recurrence ◽  
Neoadjuvant Chemoradiation ◽  
Recurrence Rates

<b><i>Background/Aim:</i></b> Neoadjuvant chemoradiation (nCRT) in rectal cancer is associated with significant long-term morbidity. It is unclear whether nCRT in resectable mesorectal fascia circumferential resection margin (mrCRM)-negative rectal cancer treated by adequate total mesorectal excision (TME) is beneficial. The aim was to determine if nCRT can be omitted in patients with MRI-assessed cT3 rectal cancer and a negative mrCRM undergoing good-quality TME. <b><i>Methods:</i></b> By means of a prospective nationwide registry (<i>n</i> = 43.147; prospective multi-center observational study), patients with cT3 rectal cancer &#x3c;12 cm from the anal verge with a negative (&#x3e;1 mm) MRI-assessed CRM undergoing radical resection from 2006 to 2008 were selected. Overall, 87 patients were available for the final analysis (TME-alone, <i>n</i> = 25; nCRT+TME, <i>n</i> = 62). Groups were balanced for age, sex, and ASA score, with a nonsignificant predominance of males in the nCRT+TME group. As main outcome measures, local and distant recurrence rates were compared between patients undergoing primary surgery (TME-alone) vs. neoadjuvant chemoradiation + surgery (nCRT+TME). <b><i>Results:</i></b> In the TME-alone group, tumors were located closer to the anal verge (<i>p</i> = 0.018) and demonstrated a smaller minimal circumferential distance from the resection margin (<i>p</i> = 0.036). TME quality was comparable, as was median follow-up (48.9 vs. 44.9 months; <i>p</i> = 0.268). Local recurrences occurred at a similar rate in the TME-alone (<i>n</i> = 1; 5.3%) and nCRT+TME groups (<i>n</i> = 3; 5.5%) (<i>p</i> = 0.994) and were diagnosed at 10 months (TME-alone) and at 8, 13, and 18 months (nCRT+TME). Distant recurrences occurred in 28.9 and 17.4% of the cases, respectively (<i>p</i> = 0.626). The analysis was limited to cT3 cancers with a negative mrCRM. In addition, caution is required when appraising these results because of the limited number of evaluable subjects (especially in the TME-alone group), which adds some uncertainty to the statistical analysis. <b><i>Conclusions:</i></b> In this cohort of patients with rectal cancer located &#x3c;12 cm from the anal verge and a negative mrCRM undergoing adequate TME, omission of nCRT had no impact onto the local recurrence rate.

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