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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 2/2016

01-02-2016 | Original Article

Rectal cancer with complete clinical response after neoadjuvant chemoradiotherapy, surgery, or “watch and wait”

Authors: Chien-Liang Lai, Mei-Ju Lai, Chang-Chieh Wu, Shu-Wen Jao, Cheng-Wen Hsiao

Published in: International Journal of Colorectal Disease | Issue 2/2016

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Abstract

Purpose

The purpose of this study was to compare the outcomes of patients treated with chemoradiotherapy with a complete clinical response followed by either a “watch and wait” strategy or a total mesorectal excision.

Methods

This was an observational retrospective study from a single institute. Patients with locally advanced rectal cancer following chemoradiotherapy with a complete clinical response from January 1, 2007 to December 31, 2014 were included.

Results

The study population consisted of 18 patients who opted for a “watch and wait” policy and 26 patients who underwent radical surgery after achieving a complete clinical response. Patients had no documented treatment complications under the watch and wait policy, while 13 patients who underwent radical surgery experienced significant morbidity. There were two local recurrences in the watch and wait group; both were treated with salvage resection and had no associated mortality. In the radical surgery group, 1 patient showed an incomplete pathologic response (ypT0N1), and the remaining 25 patients showed complete pathologic responses; 1 had a distant recurrence, which was managed non-operatively, and 2 patients died of unrelated causes. The 5-year overall survival rate and median disease-free survival time were 100 % and 69.78 months in the watch and wait group and 92.30 % and 89.04 months in the radical surgery group.

Conclusions

A watch and wait policy avoids the morbidity associated with radical surgery and preserves oncologic outcomes in our retrospective study from a single institute. It could be considered a therapeutic option in patients with locally advanced rectal cancer following chemoradiotherapy with a complete clinical response.
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Metadata
Title
Rectal cancer with complete clinical response after neoadjuvant chemoradiotherapy, surgery, or “watch and wait”
Authors
Chien-Liang Lai
Mei-Ju Lai
Chang-Chieh Wu
Shu-Wen Jao
Cheng-Wen Hsiao
Publication date
01-02-2016
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 2/2016
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-015-2460-y

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