Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1073_Библиотеки_им_академика_М_И_Перельмана
.pdf
22 Can Total Mesorectal Excision BeAvoided inT2 Rectal Cancer?
https://t.me/medicina_free
259
There is limited patient-reported outcome data focused exclusively on patients
with T2N0 disease. Among patients with T1N0 disease, one study compared the
quality of life of 17 patients who underwent local excision with 18 patients who
underwent laparoscopic TME without an ostomy [15]. Questions regarding chemotherapy or stoma-related side effects were discarded, along withthose related to
sexual dysfunction, reportedly because few patients were sexually active. With
these caveats, neither procedure showed a signicant difference compared to preoperative status at 12months in cancer-specic quality of life or colorectal-specic
quality of life measured by the European Organization for Research and Treatment
of Cancer (EORTC-QLQ-C30 and QLQ-CR38) [15]. Patients cite risk of needing
an ostomy as a major concern during rectal cancer therapy. Even among patients
with stage one disease, the contemporary rate of abdominoperineal resection is
21.5%, and an additional 12% undergo a Hartmann’s procedure [3].
When neoadjuvant or adjuvant therapies are added, the patient-reported outcomes generally favor local excision. A study of patients with cT2–3 tumors (some
with nodal involvement) who underwent neoadjuvant chemoradiation followed by
local excision had signicantly better global health status, emotional function,
social function, body image, low anterior resection syndrome (LARS) scores, and
fecal incontinence subscale scores compared to those who underwent TME [16].
Similarly, in a multicenter study of a heterogeneous group of patients (T2-T4,
N1-N2, some with neoadjuvant therapy) who underwent local excision had signicantly better mean constipation scores, less sensation of incomplete emptying,
fewer second bowel movements within 15minutes compared to those who had
TME. Interestingly, patients who had local excision alone had the best patientreported outcomes, followed by those who had a TME, then those who had a completion TME following local excision [17]. Elsewhere, a study comparing 35
patients (T1 n=25; T2 n=10) who underwent local excision with or without adjuvant chemotherapy compared to those who underwent TME (n= 32) found that
14.8% of patients who had local excision had LARS compared to 45.5% (p=0.043)
of those who underwent TME [18]. An analysis of the Transanal Endoscopic
Microsurgery after Radiochemotherapy for Rectal Cancer (CARTs) study demonstrated that 48–68months after local excision, 22% (7/32) of patients with cT1-3N0
rectal cancer had no LARS, 28% (9/32) had minor LARS, and 50% (16/32) had
major LARS [19]. Unfortunately, this study did not have LARS scores from before
treatment to assess change associated with local excision.
Short-term morbidity and patient-reported outcomes notwithstanding, durable
oncologic outcomes are why TME is the standard of care in patients with T2N0
disease [4]. In the Dutch TME trial, patients with Stage I disease (n=243, cT1–2N0)
randomized to TME alone had a 10-year local recurrence rate of just 3% [20].
Similarly, in the OCUM study, out of 197 patients with cT2N0 disease who went
straight to TME, the 5-year locoregional recurrence rate was 1.7% (95% CI, 0–3.7%)
and the 5-year disease free survival 75.9% (95% CI, 69.8–82.0%) (personal communication with Professor T Junginger). Conversely, a pooled analysis including
patients with a minimum of 3years of follow-up who underwent local excision
found a weighted average rate of local recurrence of 8.1% (n= 268/3050; 95%
260
https://t.me/medicina_free
condence interval [CI], 6.6–9.9%) among those with pT1 disease and 28.9% for
pT2 disease (n=136/545; 95% CI, 22.3–36.4%) [5]. For patients who undergo a
local excision with completion TME, the weighted local recurrence rate is 1.8%
(n=5/180; 95% CI, 1.2–6.5) for patients with pT1 disease and 4.1% (n=5/123;
95% CI, 1.7–9.4%) for those with pT2 disease [ 5]. Finally, for those who underwent adjuvant chemoradiation after TME the weighted local recurrence was 4.8%
for pT1 disease (n = 24/285; 95% CI 2.3–9.8%) and 14.7% for pT2 disease
(11.2%–19.0%) [5]. In short, excellent surgical technique and high-quality TME are
associated with exceptional oncological outcomes, and novel approaches in T2 disease seeking to increase the rates of organ preservation utilizing neoadjuvant therapy and local excision should be held to these standards.
A. Loria and F. J. Fleming
Improving Oncologic Outcomes Associated withLocal Excision
Recognizing that the oncologic benets of TME come with higher rates of shortterm morbidity, appreciable colostomy rates, and poorer patient-reported outcomes,
investigators sought to improve the oncologic outcomes associated with local excision. Drawn by the successes of chemoradiation inlocally advanced rectal cancer,
favorable retrospective data, and the high rates of pathologic complete response
following TME, the addition of neoadjuvant chemoradiation before local excision
was the logical progression of subsequent trials. Here we will compare and contrast
one post hoc analysis and randomized controlled trials comparing novel treatment
modalities (neoadjuvant chemoradiation [or total neoadjuvant therapy] followed by
local excision) to the current standard of care, TME.There are notable single-arm
studies reporting oncologic and patient-reported outcomes following CRT followed
by local excision or in case of poor response to TME, but these do not directly compare to TME [19, 21].
A post hoc analysis of patients with T2N0 disease from two separate trials was
recently published [22]. This study is informative as it contrasts two management
philosophies for early rectal cancer. This compared the survival and health-related
quality of life between 79 patients with cT2N0 who underwent neoadjuvant chemoradiation (NCRT) followed by local excision (from ACOSOG Z6041) to 79 with
pT2N0 who underwent upfront TME (from the Dutch TME trial) [22, 23]. The
5-year rate of local recurrence was 4.2% (CI, 1.4%–12.5%) in the NCRT-local excision group and 1.3% (CI, 0.2%–6.7%) in the TME group (hazard ratio, 5.42; 95%
CI, 0.59–49.64, p=0.14). Similarly, there was no difference between the groups in
5-year disease-free survival (88.2% vs. 88.3%), 5-year overall survival (90.3% vs.
88.4%), or 5-year relative survival (99.8% vs. 100%) [22]. One of the most notable
differences between the two therapeutic approaches was the marked difference in
sphincter preservation with a permanent ostomy rate of 51% in the subgroup from
the Dutch TME trial compared to a 4% ostomy rate from ACOSOG Z6041 [21].
Table 22.2 summarizes the randomized controlled trials comparing neoadjuvant
therapy followed by LE with the standard of care (TME) [11, 12, 24]. The randomized controlled trials differ in their inclusion criteria and neoadjuvant regimens but
22 Can Total Mesorectal Excision BeAvoided inT2 Rectal Cancer?
https://t.me/medicina_free
261
Table 22.2 Randomized controlled trials comparing novel treatment modalities to standard of care
Study
GRECCAR2 [24] TREC [12] TAU-TEM [11]
Quality High High High
Inclusion
criteria
Responder to NCRT
cT2–3N0–1
≤8cm from anal
cT1–2N0
Lesion <3cm diameter
cT2–3N0
≤10cm of anal verge,
lesion <4cm diameter
verge,
Lesion ≤4cm
diameter
Intervention TME
Vs.
Local excision
TME
Vs.
SCRT (25Gy) followed
by local excision in
8–10weeks
TME
Vs.
NCRT (DXT 50.4Gy
with capecitabine)
followed by local
excision in 8weeks
Intention to
treat or
modied
NCRTTME
(n=71)
NCRT-LE
(n=74)
TME
(n=28)
SCRT-LE
(n=27)
TME
(n=81)
NCRT-LE
(n=81)
intention to
treat
Grade≥3
neoadjuvant
a
toxicity
30-day
mortality
30-day
morbidity
Conversion to
TME
a
a
a
Organ
preservation
Permanent
a
ostomy
a
pCR
Local
recurrence
Distant
10% (15/145) — 15% — 3.7%
0% 0% 0% 0% 1.2% 1.2%
N=61
10%
N=53
b
6%
39% 15%
b
50.6% 20.7%
— 35% — 30% — 2.5%
12.7% 64% 3% 70% 0% 82.7%
a
7% 13% 14% 7% 19.8% 0%
40% (57/141) 0% 26% — 44.3%
5year7%5year
7%
3year
0%
3year
11%
N.A. N.A.
b
19% 18% 7% 11% N.A. N.A.
b
recurrence
Disease free
72% 70% 85% 76% N.A. N.A.
survival
Overall
82% 84% 93% 88% N.A. N.A.
survival
Cancer specic
10% 7% — — — —
mortality
N.A. no oncologic data reported at the time of writing
a
Short-term GRECCAR2 from PMID 28601342, and completion TME was performed in 27 of the
74 assigned to local excision
b
Comparison between groups p<0.05
262
https://t.me/medicina_free
are representative of novel treatment modalities for early rectal cancer. The rst
study with 5-year oncologic data was GRECCAR 2, which had oncological outcomes as secondary endpoints [24]. Here, adults with T2-T3 low rectal cancers
were all treated with long-course neoadjuvant chemoradiation. Those who responded
well to the neoadjuvant therapy (≤2cm residual tumor at a 6–8week post neoadjuvant MRI) were randomized to local excision or TME 8weeks after chemotherapy.
The 5-year local recurrence, metastasis, overall survival, and cancer-specic mortality were similar between the patients with NCRT+LE and the NCRT+TME
groups (Table22.2).
Neoadjuvant CRT is commonly used but is associated with substantial morbidity
and even mortality, as seen in the CARTS study [19]. An alternative investigated in
the TREC study is performing neoadjuvant short-course radiation (SCRT) followed
by local excision [12]. The TREC study did include non-randomized patients whose
treatment was determined by a multidisciplinary tumor board, but we will focus on
the randomized patients. In the comparison of 28 patients randomized to TME compared to SCRT followed by TEM, there was no difference in 3-year overall (93% vs.
88%, p=0.35) or 3-year disease-free survival (85% vs. 76%, p=0.12), respectively.
The most recent study (TAU-TEM) has published short-term outcomes, but no data
are available to date on oncologic outcomes [11].
The high rates of pathologic complete response following neoadjuvant chemoradiation and the mixed data regarding patient-reported outcomes following NCRT +
local excision have stimulated further investigation. Ongoing trials such as STARTREC (NCT02945566), GRECCAR12 (NCT02514278), OPERA (NCT02505750),
and ReSARCh (NCT02710812) among others are assessing whether local excision
can be avoided altogether with a watch and wait approach. Currently, there are minimal patient-reported outcomes data regarding the watch and wait strategy. The
available studies assess patients with locally advanced rectal cancer and report comparisons between watch and wait to TME.One study compared 21 patients who
underwent watch and wait to 21 who underwent sphincter preserving
TME.Expectedly, 21 patients who had watch and wait matched to 21 who had TME
had better bowel function on all of the subscales of the Memorial Sloan Kettering
Cancer Center Bowel Function Instrument [25]. These results are corroborated elsewhere in a study of patients with locally advanced rectal cancer who received watch
and wait compared to anterior resection [26]. A more appropriate comparison for
patients who undergo watch and wait is to patients who receive local excision.
A. Loria and F. J. Fleming
Recommendations Based ontheData
For a patient with cT2N0 rectal cancer who can tolerate surgery, or a patient where
frequent surveillance for tumor recrudescence is impractical or impossible, a high
quality TME is recommended to minimize their risk of recurrence and maximize
their overall survival (Evidence: strong quality; Recommendation, strong).This is
clearly the preferred approach in patients with T2N0 disease from the oncological
standpoint.
22 Can Total Mesorectal Excision BeAvoided inT2 Rectal Cancer?
https://t.me/medicina_free
In highly select patients with cT2N0 rectal cancer with prohibitively high-risk
comorbidities or refuse TME, local excision can be considered (Evidence, moderate; Recommendation, weak). These high-risk patients should be carefully
surveilled for potential completion TME salvage in the event of recrudescence.(Evidence, high quality; Recommendation, weak).
263
A Personal View oftheData
T2N0 Rectal Cancer: TheGoldilocks Effect
Given the tremendous progress in reducing locoregional recurrence rates, we contend that the pressing issues in T2N0 rectal cancer management are now the risk of
distant recurrence, minimizing acute and chronic treatment-related toxicities, and
organ preservation. For patients with a T2N0 tumor, TME, often necessitating an
abdominoperineal resection, may be ‘too much’ treatment. Conversely, local excision alone is clearly ‘too little’ treatment given the very high rates of locoregional
recurrence. So, what is the ‘just right’ amount of therapy to reduce the locoregional
risk of recurrence while minimizing toxicity and maximizing organ preservation?
Contemporary rectal cancer care is multidisciplinary and based on shared- decision
making. Many patients, even those with a complete clinical response to neoadjuvant
therapy, seek the most denitive treatment to “put the disease behind them.” For
them, a TME even with ypT0N0 is the appropriate treatment. However, it is possible
to achieve durable oncologic outcomes and organ preservation using either NCRT-LE
or TNT-WW [22, 27, 28]. Consider a 75-year-old male who lives independently with
a 2cm lesion 5cm from the anal verge under local excision and pathology revealed
a T2 tumor with clear margins positive for lymphovascular invasion tumor. The
patient is interested in curative treatment but is concerned about complications leading to a loss of independence. In this case scenario without additional therapy, one in
four patients (20–25%) will have a locoregional recurrence and 6–13% will have
distant metastasis [5]. Adding adjuvant chemoradiation would offer approximately a
50% relative risk reduction inlocoregional recurrence (10–12.5%) and distant recurrence (5–10%) [5]. A completion TME reduces the risk of locoregional recurrence to
4–5% and distant recurrence to 5–7% [5]. With proper counseling, we have employed
each of these treatment approaches to good effect.
Another scenario is a 60-year-old female with a T2N0 tumor abutting the anal
sphincter complex, who is keen to avoid a permanent colostomy, and has declined
an upfront abdominoperineal resection. There is a reasonable body of data supporting the deployment of neoadjuvant therapy, possibly followed by local excision
(NCRT-LE) ideally via a transanal endoscopic platform. This approach is associated
with 60–80% organ preservation rates among patients who met post-treatment
response criteria in clinical trials [11, 12, 24]. However, up to 10% of the patients in
these studies required completion TME.The challenge of accurately identifying
complete clinical responders to neoadjuvant therapy is a drawback of TNT-WW
[29]. While NCRT-LE provides some reassurance that residual microscopic disease
264
https://t.me/medicina_free
A. Loria and F. J. Fleming
was removed, the relatively high rates of pathologic complete response in the trials
(26–40%) and functional derangements (50% major LARS at 5years in the CARTS
study) highlight the urgent need to improve endoscopic, radiographic, and/or bloodbased (ex. circulating cell-free DNA) methods of identifying complete clinical
responders [19, 29]. There are very few patient-reported outcomes data comparing
patients who had NCRT-LE and TNT-WW, and this area needs investigation.
Presently, TNT-WW should be reserved for institutional review board approved
protocols and is not the standard of care [30].
In conclusion, the management of early rectal cancer is rapidly advancing, and
TME is an excellent option for most patients with T2N0 rectal cancer. Even patients
with early disease who could be managed with TME alone should be presented in a
tumor board setting adhering to evidence-based standards such as the National
Accreditation Program for Rectal Cancer (NAPRC) standards [31]. However, clinicians should prepare for the growing trend toward organ preservation, particularly
in light of the increasing adoption of TNT throughout the United States [32].
Surgeons should be at the forefront of investigations into pressing clinical questions
regarding patient-reported outcomes, oncologic durability, and logistical or quality
issues associated with the widespread implementation of organ preservation programs. Regardless, patients with T2N0 disease must be thoroughly counseled on the
diagnostic uncertainty in early rectal cancer and all contemporary management
options. If these patients remain highly committed to organ preservation, even
potentially at the expense of oncologic outcomes, referral to experienced centers is
recommended.
References
1. American Cancer Society. Colorectal Cancer Facts & Figures2020–2022. Atlanta: American
Cancer Society; 2020.
2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F.Global cancer
statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers
in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. https://doi.org/10.3322/caac.21660.
Epub 2021 Feb 4
3. Detering R, van Oostendorp SE, Meyer VM, van Dieren S, Bos ACRK, Dekker JWT, Reerink
O, van Waesberghe JHTM, Marijnen CAM, Moons LMG, Beets-Tan RGH, Hompes R, van
Westreenen HL, Tanis PJ, Tuynman JB, Dutch ColoRectal Audit Group*. MRI cT1-2 rectal
cancer staging accuracy: a population-based study. Br J Surg. 2020;107(10):1372–82. https://
doi.org/10.1002/bjs.11590. Epub 2020 Apr 16. PMID: 32297326; PMCID: PMC7496930
4. National Comprehensive Cancer Network. Rectal Cancer (Version 4.2022). https://www.nccn.
org/guidelines/guidelines- detail?category=1&id=1461. Accessed Feb 27 2023.
5. van Oostendorp SE, Smits LJH, Vroom Y, Detering R, Heymans MW, Moons LMG, Tanis PJ,
de Graaf EJR, Cunningham C, Denost Q, Kusters M, Tuynman JB.Local recurrence after local
excision of early rectal cancer: a meta-analysis of completion TME, adjuvant (chemo)radiation, or no additional treatment. Br J Surg. 2020;107(13):1719–30. https://doi.org/10.1002/
bjs.12040. Epub 2020 Sep 16. PMID: 32936943; PMCID: PMC7692925
6. Bipat S, Glas AS, Slors FJ, Zwinderman AH, Bossuyt PM, Stoker J.Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging–
a meta-analysis. Radiology. 2004;232(3):773–83. https://doi.org/10.1148/radiol.2323031368.
Epub 2004 Jul 23
22 Can Total Mesorectal Excision BeAvoided inT2 Rectal Cancer?
https://t.me/medicina_free
7. Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, Becker H, Raab HR,
Villanueva MT, Witzigmann H, Wittekind C, Beissbarth T, Rödel C.Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/
ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol.
2012;30(16):1926–33. https://doi.org/10.1200/JCO.2011.40.1836. Epub 2012 Apr 23. PMID:
22529255
8. Mercury Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study.
BMJ. 2006;333(7572):779. https://doi.org/10.1136/bmj.38937.646400.55. Epub 2006 Sep 19.
PMID: 16984925; PMCID: PMC1602032
9. Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rödel C, Cervantes A, Arnold D, ESMO
Guidelines Committee. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4):iv263. https://doi.org/10.1093/annonc/
mdy161. Erratum for: Ann Oncol. 2017 Jul 1;28(suppl_4):iv22–iv40
10. You YN, Baxter NN, Stewart A, Nelson H. Is the increasing rate of local excision for
stage I rectal cancer in the United States justied?: a nationwide cohort study from the
National Cancer Database. Ann Surg. 2007;245(5):726–33. https://doi.org/10.1097/01.
sla.0000252590.95116.4f. PMID: 17457165; PMCID: PMC1877081
11. Serra-Aracil X, Pericay C, Badia-Closa J, Golda T, Biondo S, Hernández P, Targarona E,
Borda-Arrizabalaga N, Reina A, Delgado S, Vallribera F, Caro A, Gallego-Plazas J, Pascual
M, Álvarez-Laso C, Guadalajara-Labajo HG, Mora-Lopez L.Short-term outcomes of chemoradiotherapy and local excision versus total mesorectal excision in T2-T3ab,N0,M0 rectal cancer: a multicentre randomised, controlled, phase III trial (the TAU-TEM study). Ann Oncol.
2023;34(1):78–90. https://doi.org/10.1016/j.annonc.2022.09.160. Epub 2022 Oct 8
12. Bach SP, Gilbert A, Brock K, Korsgen S, Geh I, Hill J, Gill T, Hainsworth P, Tutton MG,
Khan J, Robinson J, Steward M, Cunningham C, Levy B, Beveridge A, Handley K, Kaur M,
Marchevsky N, Magill L, Russell A, Quirke P, West NP, Sebag-Monteore D, TREC collaborators. Radical surgery versus organ preservation via short-course radiotherapy followed
by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised,
open-label feasibility study. Lancet Gastroenterol Hepatol. 2021;6(2):92–105. https://doi.
org/10.1016/S2468- 1253(20)30333- 2. Epub 2020 Dec 11. PMID: 33308452; PMCID:
PMC7802515
13. Ketelaers SHJ, Orsini RG, Burger JWA, Nieuwenhuijzen GAP, Rutten HJT. Signicant
improvement in postoperative and 1-year mortality after colorectal cancer surgery in recent
years. Eur J Surg Oncol. 2019;45(11):2052–8. https://doi.org/10.1016/j.ejso.2019.06.017.
Epub 2019 Jun 13
14. Claassen YHM, Bastiaannet E, van Eycken E, Van Damme N, Martling A, Johansson R,
Iversen LH, Ingeholm P, Lemmens VEPP, Liefers GJ, Holman FA, Dekker JWT, Portielje
JEA, Rutten HJ, van de Velde CJH.Time trends of short-term mortality for octogenarians
undergoing a colorectal resection in North Europe. Eur J Surg Oncol. 2019;45(8):1396–402.
https://doi.org/10.1016/j.ejso.2019.03.041. Epub 2019 Apr 9
15. Lezoche E, Paganini AM, Fabiani B, Balla A, Vestri A, Pescatori L, Scoglio D, D'Ambrosio
G, Lezoche G.Quality-of-life impairment after endoluminal locoregional resection and laparoscopic total mesorectal excision. Surg Endosc. 2014;28(1):227–34. https://doi.org/10.1007/
s00464- 013- 3166- 2. Epub 2013 Sep 4
16. Brachet S, Meillat H, Chanez B, Ratone JP, Brunelle S, Tyran M, Poizat F, de Chaisemartin C,
Lelong B.Case-matched comparison of functional and quality of life outcomes of local excision and total mesorectal excision following chemoradiotherapy for rectal cancer. Dis Colon
Rectum. 2022;65(12):1464–74. https://doi.org/10.1097/DCR.0000000000002384. Epub
2022 Jul 27
17. Pucciarelli S, Giandomenico F, De Paoli A, Gavaruzzi T, Lotto L, Mantello G, Barba C, Zotti
P, Flora S, Del Bianco P.Bowel function and quality of life after local excision or total mesorectal excision following chemoradiotherapy for rectal cancer. Br J Surg. 2017;104(1):138–47.
https://doi.org/10.1002/bjs.10318. Epub 2016 Oct 5
265
266
https://t.me/medicina_free
18. Pacevicius J, Petrauskas V, Pilipavicius L, Dulskas A.Local excision ± Chemoradiotherapy
vs. Total Mesorectal excision for early rectal cancer: case-matched analysis of long-term
results. Front Surg. 2021;18(8):746784. https://doi.org/10.3389/fsurg.2021.746784. PMID:
34733880; PMCID: PMC8558343
19. Stijns RCH, de Graaf EJR, Punt CJA, Nagtegaal ID, Nuyttens JJME, van Meerten E, Tanis
PJ, de Hingh IHJT, van der Schelling GP, Acherman Y, Leijtens JWA, Bremers AJA, Beets
GL, Hoff C, Verhoef C, Marijnen CAM, de Wilt JHW, CARTS Study Group. Long-term
oncological and functional outcomes of Chemoradiotherapy followed by organ-sparing
Transanal endoscopic microsurgery for distal rectal cancer: the CARTS study. JAMA Surg.
2019;154(1):47–54. https://doi.org/10.1001/jamasurg.2018.3752. PMID: 30304338; PMCID:
PMC6439861
20. van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, Rutten HJ,
Påhlman L, Glimelius B, Van de Velde CJ.Dutch colorectal cancer group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011;12(6):575–82.
https://doi.org/10.1016/S1470- 2045(11)70097- 3. Epub 2011 May 17
21. Garcia-Aguilar J, Renfro LA, Chow OS, Shi Q, Carrero XW, Lynn PB, Thomas CR Jr, Chan
E, Cataldo PA, Marcet JE, Medich DS, Johnson CS, Oommen SC, Wolff BG, Pigazzi A, SM
MN, Pons RK, Bleday R.Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label,
single-arm, multi-institutional, phase 2 trial. Lancet Oncol. 2015;16(15):1537–46. https://
doi.org/10.1016/S1470- 2045(15)00215- 6. Epub 2015 Oct 22. PMID: 26474521; PMCID:
PMC4984260
22. Lynn PB, Van der Valk MJM, Claassen YHM, Shi Q, Widmar M, Bastiaannet E, Van de Velde
CJH, Garcia-Aguilar J.Chemoradiation and local excision versus total mesorectal excision for
T2N0 rectal cancer: comparison of short- and long-term outcomes from 2 prospective studies.
Ann Surg. 2023;277(1):e96–e102. https://doi.org/10.1097/SLA.0000000000005052. Epub
2021 Jul 2. PMID: 34225302; PMCID: PMC8658950
23. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman
L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ, Dutch Colorectal Cancer Group.
Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer.
N Engl J Med. 2001;345(9):638–46. https://doi.org/10.1056/NEJMoa010580.
24. Rullier E, Vendrely V, Asselineau J, Rouanet P, Tuech JJ, Valverde A, de Chaisemartin C,
Rivoire M, Trilling B, Jafari M, Portier G, Meunier B, Sieleznieff I, Bertrand M, Marchal F,
Dubois A, Pocard M, Rullier A, Smith D, Frulio N, Frison E, Denost Q.Organ preservation
with chemoradiotherapy plus local excision for rectal cancer: 5-year results of the GRECCAR
2 randomised trial. Lancet Gastroenterol Hepatol. 2020;5(5):465–74. https://doi.org/10.1016/
S2468- 1253(19)30410- 8. Epub 2020 Feb 7
25. Quezada-Diaz FF, Smith JJ, Jimenez-Rodriguez RM, Wasserman I, Pappou EP, Patil S, Wei
IH, Nash GM, Guillem JG, Weiser MR, Paty PB, Garcia-Aguilar J. Patient-reported bowel
function in patients with rectal cancer managed by a watch-and-wait strategy after neoadjuvant therapy: a case-control study. Dis Colon Rectum. 2020;63(7):897–902. https://doi.
org/10.1097/DCR.0000000000001646. PMID: 32217857; PMCID: PMC7274891
26. Pascual-Russo A, Milito D, Facio L, Furia M, Forestier V, Iseas S, Méndez G, Coraglio
M, Lumi CM, Masciangioli G, Mauriño E, Vázquez H. Better quality of life and reduced
fecal incontinence in rectal cancer patients with the watch-and-wait follow-up strategy. Rev
Gastroenterol Mex (Engl Ed). 2020 Aug 28:S0375-0906(20)30090-2. English, Spanish.
https://doi.org/10.1016/j.rgmx.2020.06.0.
27. Garcia-Aguilar J, Patil S, Gollub MJ, Kim JK, Yuval JB, Thompson HM, Verheij FS, Omer
DM, Lee M, Dunne RF, Marcet J, Cataldo P, Polite B, Herzig DO, Liska D, Oommen S,
Friel CM, Ternent C, Coveler AL, Hunt S, Gregory A, Varma MG, Bello BL, Carmichael JC,
Krauss J, Gleisner A, Paty PB, Weiser MR, Nash GM, Pappou E, Guillem JG, Temple L, Wei
IH, Widmar M, Lin S, Segal NH, Cercek A, Yaeger R, Smith JJ, Goodman KA, Wu AJ, Saltz
A. Loria and F. J. Fleming
22 Can Total Mesorectal Excision BeAvoided inT2 Rectal Cancer?
https://t.me/medicina_free
LB.Organ preservation in patients with rectal adenocarcinoma treated with Total neoadjuvant
therapy. J Clin Oncol. 2022;40(23):2546–56. https://doi.org/10.1200/JCO.22.00032. Epub
2022 Apr 28. PMID: 35483010; PMCID: PMC9362876
28. Fernandez LM, São Julião GP, Figueiredo NL, Beets GL, van der Valk MJM, Bahadoer RR,
Hilling DE, Meershoek-Klein Kranenbarg E, Roodvoets AGH, Renehan AG, van de Velde
CJH, Habr-Gama A, Perez RO, International Watch & Wait Database Consortium. Conditional
recurrence-free survival of clinical complete responders managed by watch and wait after
neoadjuvant chemoradiotherapy for rectal cancer in the International Watch & Wait Database:
a retrospective, international, multicentre registry study. Lancet Oncol. 2021;22(1):43–50.
https://doi.org/10.1016/S1470- 2045(20)30557- X. Epub 2020 Dec 11
29. Nagtegaal ID, Glynne-Jones R.How to measure tumour response in rectal cancer? An explanation of discrepancies and suggestions for improvement. Cancer Treat Rev. 2020;84:101964.
https://doi.org/10.1016/j.ctrv.2020.101964. Epub 2020 Jan 17
30. You YN, Hardiman KM, Bafford A, Poylin V, Francone TD, Davis K, Paquette IM, Steele
SR, Feingold DL.On behalf of the clinical practice guidelines Committee of the American
Society of colon and Rectal surgeons. The American Society of Colon and Rectal Surgeons
clinical practice guidelines for the management of rectal cancer. Dis Colon Rectum.
2020;63(9):1191–222. https://doi.org/10.1097/DCR.0000000000001762.
31. Commission on Cancer National Accreditation Program for Rectal Cancer. Optimal Resources
for Rectal Cancer Care: 2020 Standards. Accessed January 20, 2023.
32. Liu J, Ladbury C, Glaser S, Fakih M, Kaiser AM, Chen YJ, Williams TM, Amini A.Patterns
of care for patients with locally advanced rectal cancer treated with total neoadjuvant therapy
at predominately academic centers between 2016–2020: An NCDB Analysis. Clin Colorectal
Cancer. 2023;5:S1533. https://doi.org/10.1016/j.clcc.2023.01.005. Epub ahead of print
267
Watch andWait Versus Conventional
https://t.me/medicina_free
Surgical Treatment inRectal Cancer
FelipeF.Quezada-Diaz andJ.JoshuaSmith
Introduction
The standard of care for locally advanced rectal cancer (LARC) includes neoadjuvant long-course chemoradiotherapy (LCRT), total mesorectal excision (TME) and
postoperative adjuvant chemotherapy [1]. However, over the past 2 decades, the
treatment of locally advanced rectal cancer (LARC) has evolved in an attempt to
balance between better survival outcomes and reducing long-term sequelae on the
patient’s quality of life (QoL) due to the toxicities associated with neoadjuvant
treatment (NAT) [2].
Up to 20% of LARC patients treated with LCRT alone may develop a pathological complete response (i.e. absence of residual tumor cells at either the primary
tumor site and the mesorectal nodes, pCR), but this can be as high as 40% in those
treated with concomitant consolidative chemotherapy given after LCRT [3]. Patients
with a pCR have improved survival rates, with lower than 5% of distant metastasis
and 1% of locoregional failure [4].
23
Disclosure: Dr. Smith received travel funding from Intuitive Surgical Inc. (2015) and served as a
clinical advisor for Guardant Health Inc. (2019) and Foundation Medicine Inc. (2022). He served
as a consultant and speaker for Johnson & Johnson Inc. (2022) and GSK (2023).
F. F. Quezada-Diaz
Colorectal Unit, Department of Surgery, Complejo Asistencial Doctor Sótero del Río,
Santiago, RM, Chile
J. J. Smith (*)
Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center,
New York, NY, USA
e-mail: smithj5@mskcc.org
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
K. Umanskiy, N. Hyman (eds.), Difcult Decisions in Colorectal Surgery,
Difcult Decisions in Surgery: An Evidence-Based Approach,
https://doi.org/10.1007/978-3-031-42303-1_23
269
Соседние файлы в папке Библиотека им академика М.И. Перельмана