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Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer

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Avoiding Unnecessary Major Rectal Cancer Surgery by Implementing Structural Restaging and a Watch-and-Wait Strategy

J F Huisman¹, I J H Schoenaker², R M Brohet³

¹Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, The Netherlands.

Annals of Surgical Oncology

|November 10, 2020

Summary

This summary is machine-generated.

Multidisciplinary response evaluation for rectal cancer patients after neoadjuvant chemoradiotherapy (nCRT) significantly reduced unnecessary surgeries. This approach, incorporating a watch-and-wait strategy, improved stoma-free survival rates.

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Area of Science:

Oncology
Surgical Oncology
Gastroenterology

Background:

Locally advanced rectal cancer (LARC) treatment often involves neoadjuvant chemoradiotherapy (nCRT).
Pathologic complete response (pCR) rates after nCRT range from 15-20%.
A watch-and-wait (W&W) strategy is emerging for patients achieving clinical complete response to avoid surgery.

Purpose of the Study:

To evaluate the efficacy of multidisciplinary response evaluation in LARC patients post-nCRT.
To compare pCR rates before and after implementing structured response evaluation and W&W.
To assess the impact on surgical intervention rates and stoma-free survival.

Main Methods:

Retrospective cohort study of LARC patients undergoing nCRT (2009-2018).
Cohort A (2009-2015) without structured evaluation vs. Cohort B (2015-2018) with evaluation and W&W option.
Analysis of pCR (ypT0N0), time-to-event for pCR, and stoma-free survival.

Main Results:

pCR rates were 18.4% in Cohort A vs. 8.7% in Cohort B (p=0.043).
Time-to-event analysis showed a significant decline in pCR in Cohort B (p<0.001).
Stoma-free survival was 24% higher in Cohort B (p<0.001).

Conclusions:

Multidisciplinary response evaluation significantly decreased unnecessary surgeries for complete responders.
The W&W strategy, guided by structured evaluation, improves patient outcomes and reduces surgical morbidity.
This approach optimizes treatment for LARC, balancing oncologic safety with quality of life.