Surveillance after neoadjuvant therapy in advanced rectal cancer with complete clinical response can have comparable outcomes to total mesorectal excision

International Journal of Colorectal Disease
Radhika K SmithE Carter Paulson

Abstract

While the standard of care for patients with rectal cancer who sustain a complete clinical response (cCR) to chemoradiotherapy (CRT) remains proctectomy with total mesorectal excision, data suggests that non-operative management may be a safe alternative. The purpose of this study is to compare outcomes between patients treated with CRT that attained a cCR and opted for a vigilant surveillance to those of the patients who had a complete pathologic response (cPR) following proctectomy. This is a retrospective review of patients treated for adenocarcinoma of the rectum who achieved either a cCR or a cPR following CRT. Patients with a cCR were enrolled in an active surveillance program which included regularly scheduled exams, proctoscopy, serum carcinoembryonic antigen (CEA), endorectal ultrasound, and cross-sectional imaging. Outcomes were compared to those patients who underwent proctectomy with a cPR. Our primary outcome measures were post-treatment complications, recurrence, and survival. We reviewed 18 patients who opted for surveillance after cCR and 30 patients who underwent proctectomy after a cPR. No non-operative patients had a documented treatment complication, while 17 patients with cPR suffered significant morbidity....Continue Reading

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Citations

Nov 27, 2015·International Journal of Colorectal Disease·Chien-Liang LaiCheng-Wen Hsiao
Oct 29, 2015·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·M RupinskiK Bujko
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Aug 21, 2018·Expert Review of Molecular Diagnostics·Corey TimmermanSergio Huerta
Mar 13, 2019·Journal of Oncology Practice·Mehmet Akce, Bassel F El-Rayes
Apr 3, 2020·American Society of Clinical Oncology Educational Book·Weijing SunAngelita Habr-Gama
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Jul 8, 2016·Diseases of the Colon and Rectum·Andrew D NewtonE Carter Paulson
Jul 27, 2018·ANZ Journal of Surgery·Tamara G MullaneyDavid Wattchow
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Nov 12, 2019·Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology·Joanna SochaKrzysztof Bujko

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