Clinical Outcomes of Salvage Surgery in Locally Advanced Distal Rectal Cancer Patients with Local Regrowth Following Non-operative Management

Aim: locally advanced distal rectal cancer (LADRC) patients managed with non-operative management (NOM) with complete clinical response following neoadjuvant treatment will experience local regrowth in about 25% of cases. The long-term risks of this strategy or local regrowth treatment have not been well established, and the main concern is the probability of impaired oncological outcomes after salvage surgery. This study aimed to evaluate the feasibility and clinical outcomes of salvage surgery in LADRC patients with local regrowth following NOM. Method: all locally advanced, distal rectal cancer patients managed with NOM after neoadjuvant therapy with clinical complete response, who developed local regrowth during surveillance, between May 2016 and November 2018, were enrolled in the study. Patients were analyzed for the rate of salvage surgery, disease-free survival and overall survival. Results: eleven out of 63 (17.5%) patients developed local regrowth after a mean of 8.4 (3-15) months. The mean surveillance period was 31.8 (14- 50) months. Eleven (100%) patients underwent salvage surgery due to the principles of total mesorectal excision. LE was not performed. No patients experienced local recurrence and three out of eleven (27.3%) developed carcinomatosis peritonei and/or distant metastasis after a mean surveillance period of 12.2 (3-26) months. At 30 months, the local and/or systemic recurrence rate, disease-free survival, and overall survival in the patients undergoing surgical treatment were 100%, 73%, 73% and 91%, respectively. Conclusion: the vast majority of patients with regrowth following NOM were suitable for salvage surgery with curative intent and justifiable pelvic tumor control.
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