Boubaddi Mehdi, Pluchon Alisson, Marichez Arthur, Amintas Samuel, Smith Denis, Celerier Bertrand, Vendrely Veronique, Fernandez Benjamin
Colorectal Unit, Department of Digestive Surgery, Bordeaux University Hospital, Bordeaux, France.
Tumor Biology and Tumor Bank Laboratory, CHU Bordeaux, Bordeaux, France.
Ann Surg Oncol. 2025 Aug 13. doi: 10.1245/s10434-025-18058-2.
The management of rectal cancer has been transformed by advances in neoadjuvant treatments, leading to complete response in approximately 30% of cases and making a watch-and-wait (W&W) strategy feasible; however, this approach is associated with a local regrowth (LR) rate of up to 30%, and the management of LR remains non-standardized.
We aimed to compare the oncological and quality-of-life outcomes of salvage total mesorectal excision (TME) versus local excision (LE) for LR following W&W in an expert colorectal surgery center.
This retrospective analysis included prospectively registered patients with mid and low rectal cancer who achieved complete response after neoadjuvant treatment and were subsequently managed with a W&W strategy at Bordeaux University Hospital between 2015 and 2022. The choice of treatment for LR was based on patient preferences, comorbidities, and multidisciplinary team recommendations.
A total of 103 patients were included in the W&W cohort. Among these patients, 33 (32%) developed LR, of whom 17 underwent TME, 13 underwent LE, and 3 presented with distant metastases and were not eligible for surgery.
The new LR rate was significantly higher in the LE group compared with the TME group (4 vs. 0 patients; p = 0.02). Additionally, 54% of patients in the LE group ultimately required salvage TME (n = 7/13). The LE group reported poorer quality of life in terms of mobility (p = 0.019) and anxiety/depression (p = 0.001).
A second attempt at organ preservation using LE after W&W failure may expose patients to increased oncological risk and inferior functional outcomes compared with those undergoing salvage TME. These findings highlight the need for cautious patient selection and standardized protocols when considering LE for LR following W&W.
新辅助治疗的进展改变了直肠癌的治疗方式，约30%的病例可实现完全缓解，使得观察等待（W&W）策略可行；然而，这种方法的局部复发（LR）率高达30%，且LR的管理仍未标准化。
我们旨在比较在一家专业结直肠外科中心，W&W后挽救性全直肠系膜切除术（TME）与局部切除术（LE）治疗LR的肿瘤学和生活质量结局。
这项回顾性分析纳入了2015年至2022年在波尔多大学医院接受新辅助治疗后实现完全缓解并随后采用W&W策略治疗的中低位直肠癌患者，这些患者的数据是前瞻性登记的。LR的治疗选择基于患者偏好、合并症和多学科团队建议。
W&W队列共纳入103例患者。其中，33例（32%）发生LR，17例行TME，13例行LE，3例出现远处转移，不符合手术条件。
LE组的新LR率显著高于TME组（4例对0例；p = 0.02）。此外，LE组54%的患者最终需要挽救性TME（n = 7/13）。LE组在活动能力（p = 0.019）和焦虑/抑郁（p = 0.001）方面的生活质量较差。
W&W失败后使用LE进行第二次器官保留尝试，与接受挽救性TME的患者相比，可能使患者面临更高的肿瘤学风险和更差的功能结局。这些发现凸显了在考虑对W&W后的LR采用LE时，谨慎选择患者和标准化方案的必要性。
