Is watch and wait a safe and effective way to treat rectal cancer in older patients?
Chemoradiation
Functional outcomes
Older patients
Oncological outcomes
Rectal cancer
Watch-and-wait approach
Journal
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
ISSN: 1532-2157
Titre abrégé: Eur J Surg Oncol
Pays: England
ID NLM: 8504356
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
15
11
2019
revised:
13
12
2019
accepted:
03
01
2020
pubmed:
27
1
2020
medline:
21
10
2020
entrez:
27
1
2020
Statut:
ppublish
Résumé
The aim was assess the oncological and functional outcome of the watch-and-wait (W&W) approach in older patients with a clinical (near)complete response after neoadjuvant treatment for rectal cancer. Patients were included in a W&W-approach (2004-2019) when digital rectal examination, endoscopy and MRI showed a (near)clinical complete response. Patients underwent endoscopy and MRI every 3 months during the first year, and 6-monthly thereafter. Patients aged ≥75 and ≥ 2 years of follow-up (FU) were selected. Oncological outcomes were assessed with Kaplan-Meier curves. Functional outcome was assessed with colostomy-free rate, Vaizey incontinence score, low anterior resection syndrome-score and International Prostate Syndrome Score. 43/304 (14%) of patients in a W&W-approach met the inclusion criteria. Median FU was 37 (24-109) months. 5/43(12%) developed a local regrowth. All were treated surgically, with one patient experiencing a pelvic failure. Distant metastases occurred in 3/43 patients and 4 patients died, 3 of whom not related to rectal cancer. The 3-year local regrowth-free rate was 88%, 3-year non-regrowth disease-free survival 91%, overall survival 97% and 3-year colostomy-free rate 93%. Overall, the bowel- and urinary dysfunction scores at 3, 12 and 24 months indicated good continence, no or minor LARS and moderate urinary problems. W&W for older patients with a clinical (near) complete response appears to be a safe alternative to a total mesorectal excision (TME), with a very high pelvic control rate, and few rectal cancer related deaths. Most patients can avoid major surgery and a definitive colostomy, and have a reasonable anorectal and urinary function.
Identifiants
pubmed: 31982206
pii: S0748-7983(20)30005-6
doi: 10.1016/j.ejso.2020.01.005
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
358-362Investigateurs
Jarno Melenhorst
(J)
Marit E van der Sande
(MEV)
Henderik L van Westreenen
(HLV)
A K Koen Talsma
(AKK)
Stephanie O Breukink
(SO)
David D E Zimmerman
(DDE)
Denise E Hilling
(DE)
Johannes H W de Wilt
(JHW)
Koen C M J Peeters
(KCMJ)
Eelco J R de Graaf
(EJR)
Jurriaan B Tuynman
(JB)
Dirk J A Sonneveld
(DJA)
Niels Komen
(N)
Apollo Pronk
(A)
Martijn Intven
(M)
W H Hermien Schreurs
(WHH)
Christiaan Hoff
(C)
Informations de copyright
Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.