Division of Colorectal Surgery, Duarte, California, USA.
J Surg Oncol. 2024 May;129(6):1131-1138. doi: 10.1002/jso.27604. Epub 2024 Feb 23.
Total mesorectal excision (TME) remains the standard of care for patients with rectal cancer who have an incomplete response to total neoadjuvant therapy (TNT). A minority of patients will refuse curative intent resection. The aim of this study is to examine the outcomes for these patients.
A retrospective cohort study of stage 1-3 rectal adenocarcinoma patients who underwent neoadjuvant chemoradiation therapy or TNT at a single institution. Patients either underwent TME, watch-and-wait protocol, or if they refused TME, were counseled and watched (RCW). Clinical outcomes and resource utilization were examined in each group.
One hundred seventy-one patients (Male 59%) were included with a median surveillance of 43 months. Twenty-nine patients (17%) refused TME and had shortened overall survival (OS). Twelve patients who refused TME converted to a complete clinical response (cCR) on subsequent staging with a prolonged OS. 92% of these patients had a near cCR at initial staging endoscopy. Increased physician visits and testing was utilized in RCW and WW groups.
A significant portion of patients convert to cCR and have prolonged OS. Lengthening the time to declare cCR may be considered in select patients, such as those with a near cCR at initial endoscopic staging.
对于接受总新辅助治疗（TNT）后不完全缓解的直肠腺癌患者，全直肠系膜切除术（TME）仍然是标准治疗方法。少数患者会拒绝有治愈意图的切除术。本研究旨在探讨这些患者的治疗结果。
这是一项单机构回顾性队列研究，纳入了接受新辅助放化疗或 TNT 治疗的 1-3 期直肠腺癌患者。患者要么接受 TME 治疗，要么采用观察等待方案（WW），要么如果拒绝 TME，则接受咨询和观察（RCW）。在每组中，均检查了临床结局和资源利用情况。
共纳入 171 例（男性占 59%）患者，中位随访时间为 43 个月。29 例（17%）患者拒绝 TME，总生存期（OS）缩短。12 例拒绝 TME 的患者在随后的分期检查中转为完全临床缓解（cCR），OS 延长。这些患者中有 92%在初始内镜分期时接近 cCR。RCW 和 WW 组的医生就诊和检查次数增加。
相当一部分患者转为 cCR 并延长了 OS。在某些患者中，例如那些在初始内镜分期时接近 cCR 的患者，可能需要考虑延长宣布 cCR 的时间。
