Neşşar Gürel, Demirbağ Ali Eba, Mısırlıoğlu Hasan Cem, Sezer Semih
Department of General Surgery, Yıldırım Beyazıt University, Ankara, Turkey.
Clinic of Gastrointestinal Surgery, High Speciality Hospital, Ankara, Turkey.
Turk J Gastroenterol. 2019 Nov;30(11):951-956. doi: 10.5152/tjg.2019.18984.
BACKGROUND/AIMS: Although standart treatment for non-metastatic locally advanced rectal cancer includes neoadjuvant chemoradiation followed by surgical resection, patients who have achieved complete clinical response can be followed up without surgery.
Between 2010 and 2016, 61 patients received neoadjuvant chemoradiotherapy for low rectal cancer. Those patients who achieved clinical complete response were included in the "watch and wait" protocol and did not receive surgery. The remaining patients underwent radical surgery and some of these were diagnosed as having complete response pathologically. This study compared the oncological results of clinically complete responders with those patients defined as pathologically tumor-free.
Seven patients who received neoadjuvant chemoradiotherapy were re-staged as having complete clinical response and included in the "watch and wait" approach protocol. The 5-year disease free survival was 100%. Mean follow-up was 63 months and the mean age was 57.3. Fifty-four patients underwent radical surgery and 7 of them were diagnosed as having pathological complete response. The 5-year survival was 100%. Mean follow-up was 56 months and the mean age was 50.6. All patients except one are alive without tumor recurrence in the surgery group. However, those who received surgery experienced significant morbidities due to their surgery.
The oncological results of the "watch and wait" approach patients were no different from the patients who received radical surgery and were diagnosed as having pathological complete response. Those patients in particular who required abdomino-perineal resection before chemoradiation should be informed about this approach if they have achieved complete response clinically.
背景/目的：尽管非转移性局部晚期直肠癌的标准治疗包括新辅助放化疗后手术切除，但达到临床完全缓解的患者可不行手术而进行随访观察。
2010年至2016年期间，61例低位直肠癌患者接受了新辅助放化疗。达到临床完全缓解的患者纳入“观察等待”方案，未接受手术。其余患者接受根治性手术，其中部分患者经病理诊断为完全缓解。本研究比较了临床完全缓解者与病理无肿瘤患者的肿瘤学结果。
7例接受新辅助放化疗的患者重新分期为临床完全缓解，并纳入“观察等待”方案。5年无病生存率为100%。平均随访63个月，平均年龄57.3岁。54例患者接受了根治性手术，其中7例经病理诊断为完全缓解。5年生存率为100%。平均随访56个月，平均年龄50.6岁。手术组除1例患者外，所有患者均存活且无肿瘤复发。然而，接受手术的患者因手术出现了明显的并发症。
“观察等待”方案患者的肿瘤学结果与接受根治性手术并病理诊断为完全缓解的患者无异。对于那些在放化疗前需要行腹会阴联合切除术的患者，如果他们已达到临床完全缓解，应告知其该治疗方案。
