Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology - Maastricht University, Maastricht, the Netherlands.
Department of Radiology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
Eur J Surg Oncol. 2020 Mar;46(3):358-362. doi: 10.1016/j.ejso.2020.01.005. Epub 2020 Jan 8.
The aim was assess the oncological and functional outcome of the watch-and-wait (W&W) approach in older patients with a clinical (near)complete response after neoadjuvant treatment for rectal cancer.
Patients were included in a W&W-approach (2004-2019) when digital rectal examination, endoscopy and MRI showed a (near)clinical complete response. Patients underwent endoscopy and MRI every 3 months during the first year, and 6-monthly thereafter. Patients aged ≥75 and ≥ 2 years of follow-up (FU) were selected. Oncological outcomes were assessed with Kaplan-Meier curves. Functional outcome was assessed with colostomy-free rate, Vaizey incontinence score, low anterior resection syndrome-score and International Prostate Syndrome Score.
43/304 (14%) of patients in a W&W-approach met the inclusion criteria. Median FU was 37 (24-109) months. 5/43(12%) developed a local regrowth. All were treated surgically, with one patient experiencing a pelvic failure. Distant metastases occurred in 3/43 patients and 4 patients died, 3 of whom not related to rectal cancer. The 3-year local regrowth-free rate was 88%, 3-year non-regrowth disease-free survival 91%, overall survival 97% and 3-year colostomy-free rate 93%. Overall, the bowel- and urinary dysfunction scores at 3, 12 and 24 months indicated good continence, no or minor LARS and moderate urinary problems.
W&W for older patients with a clinical (near) complete response appears to be a safe alternative to a total mesorectal excision (TME), with a very high pelvic control rate, and few rectal cancer related deaths. Most patients can avoid major surgery and a definitive colostomy, and have a reasonable anorectal and urinary function.
本研究旨在评估新辅助治疗后直肠肿瘤临床（接近）完全缓解的老年患者采用观察等待（W&W）方法的肿瘤学和功能结果。
当数字直肠检查、内窥镜和 MRI 显示（接近）临床完全缓解时，患者纳入 W&W 方法（2004-2019 年）。在最初的 1 年内，患者每 3 个月接受一次内窥镜和 MRI 检查，此后每 6 个月进行一次。选择年龄≥75 岁且随访≥2 年的患者。使用 Kaplan-Meier 曲线评估肿瘤学结果。使用无结肠造口术率、Vaizey 失禁评分、低位前切除术综合征评分和国际前列腺症状评分评估功能结果。
43/304（14%）例接受 W&W 方法的患者符合纳入标准。中位随访时间为 37（24-109）个月。5/43（12%）例患者出现局部复发。所有患者均接受手术治疗，1 例患者发生盆腔失败。3/43 例患者发生远处转移，4 例患者死亡，其中 3 例与直肠癌无关。3 年局部无复发生存率为 88%，3 年非复发生存率为 91%，总生存率为 97%，3 年无结肠造口术率为 93%。总体而言，3、12 和 24 个月时的肠和尿功能评分表明患者具有良好的控便能力，无或轻微的低位前切除综合征和中度的尿功能障碍。
对于临床（接近）完全缓解的老年患者，W&W 似乎是全直肠系膜切除术（TME）的一种安全替代方法，具有非常高的盆腔控制率，且直肠癌相关死亡率低。大多数患者可以避免接受重大手术和确定性结肠造口术，并保持合理的肛门直肠和尿功能。
