Risks of Organ Preservation in Rectal Cancer: Data From Two International Registries on Rectal Cancer
Abstract
PURPOSE Organ 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. METHODS Data 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. RESULTS Five 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). CONCLUSION Patients 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.
Article Details
Journal Info
Journal of Clinical Oncology
Lippincott Williams & Wilkins
Authors (120)
Laura M. Fernandez
Laura M. Fernandez, MD, Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal; Guilherme P. São Julião, MD, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil, Department of Surgical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil; Carlos Cerdan-Santacruz, MD, Department of Surgery, Hospital de la Princesa, Madrid, Spain; Andrew G. Renehan, MD, Manchester Cancer Research Centre, National Institute of Health and Research Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom, Colorectal and Peritoneal Oncology Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Geerard L. Beets, MD, Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands; Amjad Parvaiz, MD and Jose Azevedo, MD, Col...
Guilherme P. São Julião
Laura M. Fernandez, MD, Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal; Guilherme P. São Julião, MD, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil, Department of Surgical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil; Carlos Cerdan-Santacruz, MD, Department of Surgery, Hospital de la Princesa, Madrid, Spain; Andrew G. Renehan, MD, Manchester Cancer Research Centre, National Institute of Health and Research Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom, Colorectal and Peritoneal Oncology Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Geerard L. Beets, MD, Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands; Amjad Parvaiz, MD and Jose Azevedo, MD, Col...
Carlos Cerdan Santacruz
Department of Surgery, Hospital de la Princesa, Madrid, Spain
Andrew G. Renehan
Laura M. Fernandez, MD, Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal; Guilherme P. São Julião, MD, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil, Department of Surgical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil; Carlos Cerdan-Santacruz, MD, Department of Surgery, Hospital de la Princesa, Madrid, Spain; Andrew G. Renehan, MD, Manchester Cancer Research Centre, National Institute of Health and Research Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom, Colorectal and Peritoneal Oncology Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Geerard L. Beets, MD, Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands; Amjad Parvaiz, MD and Jose Azevedo, MD, Col...
Oscar Cano-Valderrama
Department of Surgery, Hospital de la Princesa, Madrid, Spain
Geerard L. Beets
Jose Azevedo
Laura M. Fernandez, MD, Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal; Guilherme P. São Julião, MD, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil, Department of Surgical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil; Carlos Cerdan-Santacruz, MD, Department of Surgery, Hospital de la Princesa, Madrid, Spain; Andrew G. Renehan, MD, Manchester Cancer Research Centre, National Institute of Health and Research Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom, Colorectal and Peritoneal Oncology Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Geerard L. Beets, MD, Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands; Amjad Parvaiz, MD and Jose Azevedo, MD, Col...
Blas F. Lorente
Department of Surgery, Hospital La Fé, Valencia, Spain
Rocío S. Rancaño
Department of Surgery, Hospital Clinico San Carlos de Madrid, Madrid, Spain
Eloy Espin-Basany
Colorectal Surgery Unit, Department of Surgery, Hospital Valle de Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain
Bruna B. Vailati
Laura M. Fernandez, MD, Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal; Guilherme P. São Julião, MD, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil, Department of Surgical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil; Carlos Cerdan-Santacruz, MD, Department of Surgery, Hospital de la Princesa, Madrid, Spain; Andrew G. Renehan, MD, Manchester Cancer Research Centre, National Institute of Health and Research Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom, Colorectal and Peritoneal Oncology Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Geerard L. Beets, MD, Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands; Amjad Parvaiz, MD and Jose Azevedo, MD, Col...
Per J. Nilsson
Department of Molecular Medicine and Surgery (MMK), Karolinska Institutet, Stockholm, Sweden
Cornelis J.H. Van De Velde
Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
Amjad Parvaiz
Laura M. Fernandez, MD, Colorectal Surgery, Digestive Department, Champalimaud Foundation, Lisbon, Portugal; Guilherme P. São Julião, MD, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil, Department of Surgical Oncology, Hospital Beneficencia Portuguesa, São Paulo, Brazil; Carlos Cerdan-Santacruz, MD, Department of Surgery, Hospital de la Princesa, Madrid, Spain; Andrew G. Renehan, MD, Manchester Cancer Research Centre, National Institute of Health and Research Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom, Colorectal and Peritoneal Oncology Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom; Geerard L. Beets, MD, Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands, GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands; Amjad Parvaiz, MD and Jose Azevedo, MD, Col...
Angelita Habr-Gama
Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
Rodrigo O. Perez
Department of Surgical Oncology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
Francisco Blanco Antona
Elena Yagüe Martín
Jesús Cifuentes Tébar
Alberto Parajó Calvo
Natalia Uribe Quintana
Mauricio García Alonso
Jesús Paredes Cotoré
Ana Benítez Riesco
Noelia Ibañez Cánovas
Camen Martinez Sanchez
Didac Ribe i Serrat
Guillermo Ais
Marta Jiménez Toscano
Antonio Climent
Monica Reig Pérez
José Enrique Sierra Grañón
Janire Mateo
Sebastiano Biondo
Colorectal Surgery Unit, Department of Surgery, Hospital Valle de Hebron, Universidad Autonoma de Barcelona, Barcelona, Spain
Ana Gálvez Saldaña
Carlos Álvarez Laso
Ignacio Aguirre Allende
Daniel Huerga Álvarez
Ramón Farrés Coll
Wilson M. Sánchez Bautista
Maria Teresa Torres Sánchez
Paula Dujovne
Ignasi Camps
Marta Cuadrado
Olga Maseda Díaz
Nieves Sánchez
Maria del Coral de la Vega Olías
Eloy Espin Basan
Miquel Kraft Carre
Mahdi Aghili
Marion Arnold
Oktar Asoglu
Krzysztof Bujko
Joanna Socha, MD, Jan Dlugosz Univeristy in Czestochowa, Częstochowa, Poland; and Krzysztof Bujko, MD, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
André Caiado
Carlos Carvalho
Ronald Chautems
Claudio Coco
Giuditta Chiloiro
Chris Cunningham
Petra Custers
Hester Haak
Andre D'hoore
Abdominal Surgery Department, University Hospitals Leuven, Leuven, Belgium
Gabriel Dimofte
Peirong Ding
Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
S. Duff
Natalia Felicio
Nuno Figueiredo
Wolfgang Gaertner
Jean-Pierre Gérard
Joaquim Gama-Rodrigues
Barbara Geubels
Ellen Gregory
Ivana P. Salazar
Ignacio Herrando
J. Hill
Z. Huq
Frederique Jacquinot
Anders Jakobsen
Lars Henrik Jensen
D. Jones
Amir Keshvari
Stijn H.J. Ketelaers
U. Khan
R. Kushwaha
Shahrzad Kordnejad
Kurt Leitner
Robert Madoff
Lee Malcomson
Anna Martling
Karolinska Institutet, Stockholm, Sweden
Katja Fechner
Klaus E. Matzel
Claudia Mazzarisi
Elma Meershoek
Jarno Melenhorst
Mohammed Nouritaromlou
Goffredo Paolo
Alexander Pennings
Sthela M. Murad-Regadas
Rafael Pandini
Koen C.M.J. Peeters
S. Rawat
D. Richards
Isadora Rosa
Gustavo Rossi
Harm J.T. Rutten
Fernando Sanchez Loria
Inês Santiago
K.H. Siddiqui
M.H. Solkar
Arthur Sun Myint
K. Telford
J. Tang
Sofieke Temmink
Handan Tokmak
Carlos A. Vaccaro
S. Ward
Albert M. Wolthuis
Lameris Wytze
Jiehai Yu
Zhen Zhang