Vaccaro Carlos Alberto, Yazyi Federico Julio, Ojra Quintana Guillermo, Santino Juan Pablo, Sardi Mabel Edith, Beder Damián, Tognelli Joaquin, Bonadeo Fernando, Lastiri José María, Rossi Gustavo Leandro
Servicio Cirugía General, Sector de Coloproctología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Servicio Cirugía General, Sector de Coloproctología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Cir Esp. 2016 May;94(5):274-9. doi: 10.1016/j.ciresp.2015.12.007. Epub 2016 Mar 12.
The standard treatment for locally advanced rectal cancer is total mesorectal excision. However, organ preservation has been proposed for tumors with good response to neoadjuvant treatment. The aim of this study was to evaluate the oncologic results of this strategy.
This is a retrospective cohort study (2005-2014) including a consecutive series of patients with rectal adenocarcinoma with complete or almost complete clinical response after preoperative chemo-radiotherapy, that were treated according to a strategy of preservation of the rectum.
A total of 204 patients with rectal cancer received neoadjuvant therapy. Thirty (14.7%) had a good response and were treated with rectal preservation (23 «Watch and Wait» and 7 local resections). Median follow-up was 46 months (interquartile range: 30-68). In the group of «Watch & Wait», 4 patients had local recurrence before 12 months (actuarial local recurrence rate=18.5%). All of them underwent salvage surgery (2 with radical surgery and 2 local resections) without any further recurrence. Disease-free survival actuarial rate at 3 years follow-up was 94.1% (95% CI 82.9-100). None of the 7 patients that were treated by local excision had local recurrence. The organ preservation rate for the whole group was 93%.
The strategy of organ preservation in locally advanced rectal cancer is feasible in cases with good response to neoadjuvant therapy. When implemented in a highly selected group of patients this strategy is associated with satisfactory oncologic results.
局部晚期直肠癌的标准治疗方法是全直肠系膜切除术。然而，对于对新辅助治疗反应良好的肿瘤，有人提出了器官保留的方法。本研究的目的是评估该策略的肿瘤学结果。
这是一项回顾性队列研究（2005 - 2014年），纳入了一系列连续的直肠腺癌患者，这些患者在术前放化疗后有完全或几乎完全的临床反应，并根据直肠保留策略进行治疗。
共有204例直肠癌患者接受了新辅助治疗。其中30例（14.7%）反应良好，接受了直肠保留治疗（23例“观察等待”和7例局部切除术）。中位随访时间为46个月（四分位间距：30 - 68个月）。在“观察等待”组中，4例患者在12个月前出现局部复发（精算局部复发率 = 18.5%）。他们均接受了挽救性手术（2例根治性手术和2例局部切除术），此后未再复发。3年随访时的无病生存精算率为94.1%（95%可信区间82.9 - 100）。7例接受局部切除术的患者均未出现局部复发。整个组的器官保留率为93%。
对于对新辅助治疗反应良好的局部晚期直肠癌患者，器官保留策略是可行的。在经过严格筛选的患者群体中实施该策略，其肿瘤学结果令人满意。
