1. Early and late morbidity of local excision after chemoradiotherapy for rectal cancer
- Author
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A. Valverde, Eric Rullier, M. Capdepont, B Lelong, F. Marchal, G. Portier, Jean-Luc Faucheron, M. Rivoire, Philippe Rouanet, M. Jafari, B. Meunier, B Teste, M Prudhomme, Quentin Denost, I Sielezneff, Jean-Jacques Tuech, A. Dubois, Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], UNICANCER - Institut régional du Cancer Montpellier Val d'Aurelle (ICM), CRLCC Val d'Aurelle - Paul Lamarque, Hôpital Charles Nicolle [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Groupe Hospitalier Diaconesses Croix Saint-Simon, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre Léon Bérard [Lyon], Hôpital Michallon, Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, Chirurgie Générale et Digestive [Purpan], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Pontchaillou [Rennes], Hôpital de la Timone [CHU - APHM] (TIMONE), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), UNICANCER, Hôpital Hôtel-Dieu de Clermont-Ferrand, and CHU Clermont-Ferrand
- Subjects
Local excision ,medicine.medical_specialty ,AcademicSubjects/MED00910 ,Colorectal cancer ,medicine.medical_treatment ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery ,030230 surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Humans ,Medicine ,Neoadjuvant therapy ,Neoplasm Staging ,MESH: Chemoradiotherapy ,MESH: Treatment Outcome ,MESH: Humans ,Rectal Neoplasms ,business.industry ,MESH: Rectal Neoplasms ,[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,Chemoradiotherapy ,MESH: Neoplasm Staging ,General Medicine ,medicine.disease ,Total mesorectal excision ,Surgical morbidity ,Surgery ,Treatment Outcome ,MESH: Morbidity ,030220 oncology & carcinogenesis ,Original Article ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,sense organs ,Morbidity ,AcademicSubjects/MED00010 ,business ,Neoadjuvant chemoradiotherapy - Abstract
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 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.
- Published
- 2021