You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Local Excision After Preoperative Chemoradiotherapy for Rectal Cancer: Results of a Multicenter Phase II Clinical Trial

Pucciarelli, Salvatore M.D.1; De Paoli, Antonino M.D.2; Guerrieri, Mario M.D.3; La Torre, Giuseppe M.D.4; Maretto, Isacco M.D.1; De Marchi, Francesco M.D.5; Mantello, Giovanna M.D.6; Gambacorta, Maria Antonietta M.D.7; Canzonieri, Vincenzo M.D.8; Nitti, Donato M.D.1; Valentini, Vincenzo M.D.7; Coco, Claudio M.D.9

Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0b013e3182a2303e
Original Contributions: Colorectal/Anal Neoplasia
Abstract

BACKGROUND: Transanal local excision has been suggested as an attractive approach for patients with rectal cancer who show a major clinical response after preoperative chemoradiotherapy.

OBJECTIVE: To evaluate the impact of transanal local excision on the local recurrence of rectal cancer in patients who had a major clinical response after preoperative chemoradiotherapy.

DESIGN: Sequential 2-stage phase II study for early efficacy.

SETTING: Multicenter study.

PATIENTS: Patients with clinical T3 or low-lying T2 rectal adenocarcinoma that showed a major clinical response after a preoperative chemoradiotherapy. Eligible patients underwent a full-thickness transanal local excision. According to their histopathology, the patients staged as ypT0-1 were observed, while the remaining patients were recommended to undergo a subsequent total mesorectal excision.

MAIN OUTCOME MEASURES: A local recurrence rate of ≤5% was set as a successful rate for stopping the trial early after the first stage.

RESULTS: The study group included 63 patients. Before chemoradiotherapy, patients were staged as clinical T3 (n = 42) and T2 (n = 21). After the local excision, 43 patients fulfilled the criteria to be observed with no further treatment. Nine of the remaining 20 patients for whom a subsequent total mesorectal excision was recommended refused surgery. Two of these patients who refused surgery had intraluminal local recurrence; both had a ypT2 tumor and underwent salvage surgery. The estimated cumulative 3-year overall survival, disease-free survival and local disease-free survival were 91.5% (95% CI: 75.9–97.2), 91.0% (95% CI: 77.0–96.6) and 96.9% (95% CI: 80.3–99.5), respectively.

LIMITATIONS: The time of follow-up is still short and the sample size is limited.

CONCLUSIONS: Our data suggest that local excision is a good option for patients with a major clinical response after chemoradiotherapy. A longer period of follow-up is required to confirm these findings.

Author Information

1Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy

2Department of Radiation Oncology, National Cancer Institute, Aviano, Italy

3General Surgery, University Politecnica delle Marche, Ancona, Italy

4Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy

5Department of Surgical Oncology, National Cancer Institute, Aviano, Italy

6Department of Radiotherapy, State Hospital, Ancona, Italy

7Department of Radiotherapy, Catholic University of Rome, Rome, Italy

8Department of Pathology, National Cancer Institute, Aviano, Italy

9Department of Surgical Sciences, Catholic University of Rome, Rome, Italy

Funding/Support: This work was partially supported by the AIRC (Associazione Italiana Ricerca sul Cancro) Regional Grant (2008).

Financial disclosure: the authors have no competing interests to declare.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, Phoenix, AZ, April 27 to May 1, 2013.

Correspondence: Salvatore Pucciarelli, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy. E-mail: puc@unipd.it

© 2013 The American Society of Colon and Rectal Surgeons