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Risks of Organ Preservation in Rectal Cancer: Data From Two International Registries on Rectal Cancer

Fernandez, L. M.
; 
Sao Juliao, G. P.
; 
Santacruz, C. C.
; 
Renehan, A. G.
; 
Cano-Valderrama, O.
; 
Beets, G. L.
; 
Azevedo, J.
; 
Lorente, B. F.
; 
Rancano, R. S.
; 
Biondo, S.
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Abstract
PURPOSEOrgan preservation has become an attractive alternative to surgery (total mesorectal excision [TME]) among patients with rectal cancer after neoadjuvant therapy who achieve a clinical complete response (cCR). Nearly 30% of these patients will develop local regrowth (LR). Although salvage resection is frequently feasible, there may be an increased risk for development of subsequent distant metastases (DM). The aim of this study is to compare the risk of DM between patients with LR after Watch and Wait (WW) and patients with near-complete pathologic response (nPCR) managed by TME at the time of reassessment of response.METHODSData from patients enrolled in the International Watch & Wait Database (IWWD) with cCR managed by WW and subsequent LR were compared with patients managed by TME (with <= 10% cancer cells-nPCR) from the Spanish Rectal Cancer Project (VIKINGO project). The primary end point was DM-free survival at 3 years from decision to WW or TME. The secondary end point was possible risk factors associated with DM.RESULTSFive hundred and eight patients with LR were compared with 893 patients with near-complete response after TME. Overall, DM rate was significantly higher among LRs (22.8% v 10.2%; P <= .001). Independent risk factors for DM included LR (v TME at reassessment; P = .001), ypT3-4 status (P = .016), and ypN+ status (P = .001) at the time of surgery. 3-year DM-free survival was significantly worse for patients with LR (75% v 87%; P = .001). When stratified for pathologic stage, patients with LR did significantly worse through all stages (P <= .009).CONCLUSIONPatients with LR appear to have a higher risk for subsequent DM development than patients with nPCR managed by TME at restaging irrespective of final pathology. Leaving the primary undetectable tumor in situ until development of LR may result in worse oncologic outcomes.
Authors
Fernandez, L. M.
Sao Juliao, G. P.
Santacruz, C. C.
Renehan, A. G.
Cano-Valderrama, O.
Beets, G. L.
Azevedo, J.
Lorente, B. F.
Rancano, R. S.
Biondo, S.
Espin-Basany, E.
Vailati, B. B.
Nilsson, P. J.
Martling, A.
van de Velde, C. J. H.
Parvaiz, A.
Habr-Gama, A.
Perez, R. O.
Int, W.
Wait Database Consortium, I.
Spanish Rectal Cancer Viking Consortium, V.
Affiliation
Champalimaud Fdn, Digest Dept, Colorectal Surg, Lisbon, Portugal Hosp Alemao Oswaldo Cruz, Sao Paulo, Brazil Hosp Beneficencia Portuguesa, Dept Surg Oncol, Sao Paulo, Brazil Hosp Princesa, Dept Surg, Madrid, Spain Univ Manchester, Natl Inst Hlth, Fac Biol Med & Hlth, Manchester Canc Res Ctr, Manchester, England Univ Manchester, Res Manchester Biomed Res Ctr, Sch Med Sci, Manchester, England Christie Natl Hlth Serv Fdn Trust, Colorectal & Peritoneal Oncol Ctr, Manchester, England Netherlands Canc Inst, Dept Surg, Amsterdam, Netherlands Maastricht Univ, GROW Sch Oncol & Dev Biol, Maastricht, Netherlands Cruces, Vizcaya, Spain Hosp Clin San Carlos Madrid, Dept Surg, Madrid, Spain Univ Autonoma Barcelona, Hosp Valle Hebron, Dept Surg, Colorectal Surg Unit, Barcelona, Spain Karolinska Inst, Dept Mol Med & Surg MMK, Stockholm, Sweden Leiden Univ, Dept Surg, Med Ctr, Leiden, Netherlands
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2025
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All Christie Publications
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Article
Citation
Fernandez LM, Sao Juliao GP, Santacruz CC, Renehan AG, Cano-Valderrama O, Beets GL, et al. Risks of Organ Preservation in Rectal Cancer: Data From Two International Registries on Rectal Cancer. JOURNAL OF CLINICAL ONCOLOGY. 2025 MAY 10;43(14). PubMed PMID: WOS:001481967700004. English.
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https://christie.openrepository.com/handle/10541/628085
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