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Can Standard Surgical Procedure Reliably Be Avoided in Major Responders After Radio(chemo)therapy?

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Multidisciplinary Management of Rectal Cancer

Abstract

Pathological complete response (pCR) after radiochemotherapy (RCT) is increasingly reported with a range between 10% and 30%. Patients with pCR have favorable oncological outcome so that major surgery with total mesorectal excision (TME) is questionable and could be considered an overtreatment specially looking at the high rate of short- and long-term morbidity associated with this operation. “Wait and see” policy has been proposed by some authors in major responders as an alternative to radical resection. Nevertheless, clinical complete response (cCR) is a concept not easy to define, and it is not truly trustworthy in predicting pCR (25–85%) also using latest available imaging diagnostic techniques. Full-thickness local excision (LE) after RCT seems much more reliable and can be regarded as an optimal choice to achieve a definition of pathological response of primary tumor. The accuracy of LE in the definition of ypT is extremely high, and in ypT0, it is possible to predict, in a roundabout way, the absence of lymph node involvement with an accuracy of nearly 96%. Clinical trials to confirm validity of this less-invasive therapeutic approach are required.

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Abbreviations

cCR:

Clinical complete response

CT:

Chemotherapy

DFS:

Disease-free survival

DWI:

Diffusion-weighted imaging

LE:

Local excision

MRI:

Magnetic resonance imaging

OS:

Overall survival

pCR:

Pathological complete response

PET:

Positron emission tomography

RCT:

Radiochemotherapy

TEM:

Transanal endoscopic microsurgery

TME:

Total mesorectal excision

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Authors and Affiliations

  1. Department of General Surgery, Catholic University of Sacred Heart, Rome, Italy

    Claudio Coco & Gianluca Rizzo

  2. Complesso Integrato Columbus, U.O.C. Chirurgia Generale 2, Via Moscati 31-33, Rome, 00168, Italy

    Claudio Coco & Gianluca Rizzo

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  1. Claudio Coco
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  2. Gianluca Rizzo
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Correspondence to Claudio Coco .

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Editors and Affiliations

  1. , Dept. of Radiation Therapy, Università Cattolica S.Cuore, Largo A.Gemelli 8, Rome, 00168, Italy

    Vincenzo Valentini

  2. Klinik und Poliklinik Innere Medizin IV, Abt. Hämatologie und Onkologie, Universitätsklinikum Halle-Wittenberg, Ernst-Grube-Str. 40, Halle, 06097, Sachsen-Anhalt, Germany

    Hans-Joachim Schmoll

  3. Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands

    Cornelis J. H. van de Velde

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Coco, C., Rizzo, G. (2012). Can Standard Surgical Procedure Reliably Be Avoided in Major Responders After Radio(chemo)therapy?. In: Valentini, V., Schmoll, HJ., van de Velde, C. (eds) Multidisciplinary Management of Rectal Cancer. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-25005-7_29

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  • DOI: https://doi.org/10.1007/978-3-642-25005-7_29

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