Rectal Sparing Approach after preoperative Radio- and/or Chemo-therapy (ReSARCh): a prospective, multicenter,...

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Rectal-sparing approaches are emerging for rectal cancer patients with complete or major response post-neoadjuvant therapy.
• The feasibility and outcomes of these approaches remain under investigation and are debated.
• This study aimed to assess the efficacy of preserving the rectum without negatively impacting patient outcomes.

Purpose of the Study:

• To evaluate the feasibility of rectal-sparing strategies in rectal cancer management.
• To determine if rectum preservation impacts oncological and survival outcomes.
• To investigate outcomes following transanal local excision or watch-and-wait approaches.

Main Methods:

• A prospective, multicenter, observational study involving 178 patients with clinical stage II-III mid-low rectal adenocarcinoma.
• Patients received neoadjuvant therapy followed by either transanal local excision or a watch-and-wait strategy.
• Primary endpoint was rectum preservation; secondary endpoints included overall survival, disease-free survival, recurrence rates, and stoma-free survival at 3 years.

Main Results:

• The rectum was preserved in 80.9% of patients at a median follow-up of 36.1 months.
• Three-year survival rates were high: overall survival (97.6%), disease-free survival (90.0%), local recurrence-free survival (94.7%), and distant recurrence-free survival (94.6%).
• The 3-year stoma-free survival was 95.0%, with a 71.8% regrowth-free survival in the watch-and-wait group.

Conclusions:

• Rectal preservation is feasible in approximately 80% of rectal cancer patients with a major or complete response to neoadjuvant therapy.
• These rectal-sparing approaches can be performed without compromising oncological outcomes or survival.
• The findings support the consideration of organ-preserving strategies in selected rectal cancer patients.