Organ Preservation in Rectal Cancer Management: A Prospective GRECCAR Snapshot Study.

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Organ preservation strategies, including watch and wait and local excision, are increasingly adopted in rectal cancer management.
• Total neoadjuvant therapy (TNT) improves complete response rates, potentially expanding organ preservation indications.

Purpose of the Study:

• To evaluate the real-world implementation of organ preservation strategies in non-metastatic rectal cancer patients in France.
• To assess short-term oncologic outcomes for watch and wait versus local excision in rectal cancer management.

Main Methods:

• Prospective, multicenter, observational cohort study involving 27 French GRECCAR centers.
• Inclusion of patients with biopsy-proven, non-metastatic rectal adenocarcinoma treated with neoadjuvant therapy and organ preservation intent.
• Categorization into selective (early-stage) or opportunistic (advanced-stage) strategies, managed with watch-and-wait or local excision.

Main Results:

• Organ preservation was utilized in 26% of patients, predominantly via the selective strategy and watch and wait (78%).
• Total neoadjuvant therapy was the most common regimen (67%).
• Comparable short-term oncologic outcomes (overall survival, disease-free survival, local recurrence-free survival, total mesorectal excision-free survival) were observed between watch and wait and local excision. Distant metastases were more frequent in the opportunistic strategy group.

Conclusions:

• Organ preservation strategies, supported by TNT, are feasible and safe across rectal cancer stages in a nationwide French cohort.
• Watch and wait and local excision show comparable short-term oncologic outcomes, supporting their role in individualized treatment pathways.
• The study's short follow-up limits assessment of long-term outcomes and late recurrences.