Early and late morbidity of local excision after chemoradiotherapy for rectal cancer.
Journal
BJS open
ISSN: 2474-9842
Titre abrégé: BJS Open
Pays: England
ID NLM: 101722685
Informations de publication
Date de publication:
07 05 2021
07 05 2021
Historique:
received:
05
03
2021
accepted:
08
04
2021
entrez:
7
6
2021
pubmed:
8
6
2021
medline:
15
12
2021
Statut:
ppublish
Résumé
Local excision (LE) after chemoradiotherapy is a new option in low rectal cancer, but morbidity has never been compared prospectively with total mesorectal excision (TME). Early and late morbidity were compared in patients treated either by LE or TME after neoadjuvant chemoradiotherapy for rectal cancer. This was a post-hoc analysis from a randomized trial. Patients with clinical T2/T3 low rectal cancer with good response to the chemoradiotherapy and having either LE, LE with eventual completion TME, or TME were considered. Early (1 month) and late (2 years) morbidities were compared between the three groups. There were no deaths following surgery in any of the three groups. Early surgical morbidity (20 per cent LE versus 36 per cent TME versus 43 per cent completion TME, P = 0.025) and late surgical morbidity (4 per cent versus 33 per cent versus 57 per cent, P < 0.001) were significantly lower in the LE group than in the TME or the completion TME group. of LE, was associated with the lowest rate of early (10 versus 18 versus 21 per cent, P = 0.217) and late medical morbidities (0 versus 7 versus 7 per cent, P = 0.154), although this did not represent a significant difference between the groups. The severity of overall morbidity was significantly lower at 2 years after LE compared with TME or completion TME (4 versus 28 versus 43 per cent grade 3-5, P < 0.001). The rate of surgical complications after neoadjuvant chemoradiotherapy in the LE group was half that of TME group at 1 month and 10 times lower at 2 years. LE is a safe approach for organ preservation and should be considered as an alternative to watch-and-wait in complete clinical responders and to TME in subcomplete responders.
Sections du résumé
BACKGROUND
Local excision (LE) after chemoradiotherapy is a new option in low rectal cancer, but morbidity has never been compared prospectively with total mesorectal excision (TME). Early and late morbidity were compared in patients treated either by LE or TME after neoadjuvant chemoradiotherapy for rectal cancer.
METHOD
This was a post-hoc analysis from a randomized trial. Patients with clinical T2/T3 low rectal cancer with good response to the chemoradiotherapy and having either LE, LE with eventual completion TME, or TME were considered. Early (1 month) and late (2 years) morbidities were compared between the three groups.
RESULTS
There were no deaths following surgery in any of the three groups. Early surgical morbidity (20 per cent LE versus 36 per cent TME versus 43 per cent completion TME, P = 0.025) and late surgical morbidity (4 per cent versus 33 per cent versus 57 per cent, P < 0.001) were significantly lower in the LE group than in the TME or the completion TME group. of LE, was associated with the lowest rate of early (10 versus 18 versus 21 per cent, P = 0.217) and late medical morbidities (0 versus 7 versus 7 per cent, P = 0.154), although this did not represent a significant difference between the groups. The severity of overall morbidity was significantly lower at 2 years after LE compared with TME or completion TME (4 versus 28 versus 43 per cent grade 3-5, P < 0.001).
CONCLUSION
The rate of surgical complications after neoadjuvant chemoradiotherapy in the LE group was half that of TME group at 1 month and 10 times lower at 2 years. LE is a safe approach for organ preservation and should be considered as an alternative to watch-and-wait in complete clinical responders and to TME in subcomplete responders.
Identifiants
pubmed: 34097005
pii: 6294246
doi: 10.1093/bjsopen/zrab043
pmc: PMC8183183
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT00427375']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.
Références
Lancet Oncol. 2015 Nov;16(15):1537-1546
pubmed: 26474521
Dis Colon Rectum. 2013 Dec;56(12):1349-56
pubmed: 24201388
Br J Surg. 2018 Oct;105(11):1510-1518
pubmed: 29846017
Lancet Gastroenterol Hepatol. 2020 May;5(5):465-474
pubmed: 32043980
Lancet Oncol. 2016 Feb;17(2):174-183
pubmed: 26705854
Lancet Gastroenterol Hepatol. 2018 Dec;3(12):825-836
pubmed: 30318451
Lancet Oncol. 2013 Mar;14(3):210-8
pubmed: 23395398
JAMA Oncol. 2019 Apr 1;5(4):e185896
pubmed: 30629084
Br J Surg. 2016 Jul;103(8):1069-75
pubmed: 27146472
Dis Colon Rectum. 2016 Oct;59(10):984-97
pubmed: 27602930
Lancet. 2017 Jul 29;390(10093):469-479
pubmed: 28601342
Ann Surg. 2007 May;245(5):726-33
pubmed: 17457165
Ann Surg. 2004 Oct;240(4):711-7; discussion 717-8
pubmed: 15383798
Dis Colon Rectum. 2017 May;60(5):459-468
pubmed: 28383445
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
Lancet. 2018 Jun 23;391(10139):2537-2545
pubmed: 29976470
Br J Surg. 2012 Sep;99(9):1211-8
pubmed: 22864880
Ann Surg. 2018 May;267(5):910-916
pubmed: 28252517
JAMA Surg. 2019 Jan 1;154(1):47-54
pubmed: 30304338
Br J Surg. 2015 Jun;102(7):853-60
pubmed: 25847025
J Natl Cancer Inst. 2016 Aug 10;108(12):
pubmed: 27509881
Br J Surg. 2007 Nov;94(11):1421-6
pubmed: 17661311