Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Techniques in Coloproctology
Published in: Techniques in Coloproctology 9/2019

01-09-2019 | Rectal Cancer | Original Article

Individual participant data pooled-analysis of risk factors for recurrence after neoadjuvant radiotherapy and transanal local excision of rectal cancer: the PARTTLE study

Authors: A. Arezzo, G. Lo Secco, R. Passera, L. Esposito, M. Guerrieri, M. Ortenzi, K. Bujko, R. O. Perez, A. Habr-Gama, F. Stipa, M. Picchio, A. Restivo, L. Zorcolo, C. Coco, G. Rizzo, M. Mistrangelo, M. Morino

Published in: Techniques in Coloproctology | Issue 9/2019

Login to get access

Abstract

Background

An organ-preserving strategy may be a valid alternative in the treatment of selected patients with rectal cancer after neoadjuvant radiotherapy. Preoperative assessment of the risk for tumor recurrence is a key component of surgical planning. The aim of the present study was to increase the current knowledge on the risk factors for tumor recurrence.

Methods

The present study included individual participant data of published studies on rectal cancer surgery. The literature was reviewed according to according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Individual Participant Data checklist (PRISMA-IPD) guidelines. Series of patients, whose data were collected prospectively, having neoadjuvant radiotherapy followed by transanal local excision for rectal cancer were reviewed. Three independent series of univariate/multivariate binary logistic regression models were estimated for the risk of local, systemic and overall recurrence, respectively.

Results

We identified 15 studies, and 7 centers provided individual data on 517 patients. The multivariate analysis showed higher local and overall recurrences for ypT3 stage (OR 4.79; 95% CI 2.25–10.16 and OR 6.43 95% CI 3.33–12.42), tumor size after radiotherapy > 10 mm (OR 5.86 95% CI 2.33–14.74 and OR 3.14 95% CI 1.68–5.87), and lack of combined chemotherapy (OR 3.68 95% CI 1.78–7.62 and OR 2.09 95% CI 1.10–3.97), while ypT3 was the only factor correlated with systemic recurrence (OR 5.93). The analysis of survival curves shows that the overall survival is associated with ypT and not with cT.

Conclusions

Local excision should be offered with caution after neoadjuvant chemoradiotherapy to selected patients with rectal cancers, who achieved a good response to neoadjuvant chemoradiotherapy.
Literature
1.
Vennix S, Pelzers L, Bouvy N et al (2014) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev 4:CD005200
2.
Habr-Gama A, Sao Juliao GP, Perez RO (2015) Nonoperative management of rectal cancer: identifying the ideal patients. Hematol Oncol Clin N Am 29:135–151CrossRef
3.
Smith FM, Waldron D, Winter DC (2010) Rectum-conserving surgery in the era of chemoradiotherapy. Br J Surg 97:1752–1764CrossRef
4.
Stewart LA, Clarke M, Rovers M, PRISMA-IPD Development Group et al (2015) Preferred reporting items for systematic review and meta-analyses of individual participant data: the PRISMA-IPD statement. JAMA 313:1657–1665CrossRef
5.
Agenzia Italia del Farmaco (2008) Linee guida per la classificazione e la conduzione degli studi osservazionali sui farmaci. Roma
6.
Development Core Team (2008) A language and environment for statistical computing. Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0. http://​www.​R-project.​org. Accessed 1 Feb 2019
7.
Guerrieri M, Gesuita R, Ghiselli R et al (2014) Treatment of rectal cancer by transanal endoscopic microsurgery: experience with 425 patients. World J Gastroenterol 28(20):9556–9563CrossRef
8.
Stipa F, Picchio M, Burza A et al (2014) Long-term outcome of local excision after preoperative chemoradiation for ypT0 rectal cancer. Dis Colon Rectum 57:1245–1252CrossRef
9.
Coco C, Rizzo G, Mattana C et al (2013) Transanal endoscopic microsurgery after neoadjuvant radiochemotherapy for locally advanced extraperitoneal rectal cancer: short-term morbidity and functional outcome. Surg Endosc 27:2860–2867CrossRef
10.
Arezzo A, Arolfo S, Allaix ME et al (2015) Results of neoadjuvant short-course radiation therapy followed by transanal endoscopic microsurgery for T1–T2 N0 extraperitoneal rectal cancer. Int J Radiat Oncol Biol Phys 92:299–306CrossRef
11.
Restivo A, Zorcolo L, D’Alia G et al (2016) Risk of complications and long-term functional alterations after local excision of rectal tumors with transanal endoscopic microsurgery (TEM). Int J Colorectal Dis 31:257–266CrossRef
12.
Bujko K, Richter P, Smith FM et al (2013) Preoperative radiotherapy and local excision of rectal cancer with immediate radical re-operation for poor responders: a prospective multicentre study. Radiother Oncol 106:198–205CrossRef
13.
Perez RO, Habr-Gama A, Sao Juliao GP et al (2016) Transanal endoscopic microsurgery (TEM) following neoadjuvant chemoradiation for rectal cancer: outcomes of salvage resection for local recurrence. Ann Surg Oncol 23:1143–1148CrossRef
14.
Lezoche E, Baldarelli M, Lezoche G et al (2012) Randomized clinical trial of endoluminal locoregional resection versus laparoscopic total mesorectal excision for T2 rectal cancer after neoadjuvant therapy. Br J Surg 99:1211–1218CrossRef
15.
Garcia-Aguilar J, Renfro LA, Chow OS et al (2015) Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol 16:1537–1546CrossRef
16.
Lezoche G, Baldarelli M, Guerrieri M et al (2008) A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 22:352–358CrossRef
17.
Cutting JE, Hallam SE, Thomas MG, Messenger DE (2018) A systematic review of local excision followed by adjuvant therapy in early rectal cancer: are pT1 tumors the limit? Colorectal Dis 20:854–863CrossRef
18.
Perez RO, Habr-Gama A, Sao Juliao GP et al (2011) Transanal endoscopic microsurgery for residual rectal cancer after neoadjuvant chemoradiation therapy is associated with significant immediate pain and hospital readmission rates. Dis Colon Rectum 54:545–551CrossRef
19.
Marks JH, Valsdottir EB, DeNittis A et al (2009) Transanal endoscopic microsurgery for the treatment of rectal cancer: comparison of wound complication rates with and without neoadjuvant radiation therapy. Surg Endosc 23:1081–1087CrossRef
20.
Rullier E, Rouanet P, Tuech JJ et al (2017) Organ preservation for rectal cancer (GRECCAR 2): a prospective, randomised, open-label, multicentre, phase 3 trial. Lancet 390:469–479CrossRef
21.
Garcia-Aguilar J, Renfro LA, Chow OS et al (2015) Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol 16(15):1537–1546CrossRef
22.
Pucciarelli S, De Paoli A, Guerrieri M et al (2013) Local excision after preoperative chemoradiotherapy for rectal cancer: results of a multicenter phase II clinical trial. Dis Colon Rectum 56(12):1349–1356CrossRef
23.
Bach SP, Hill J, Monson JR et al (2009) A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg 96:280–290CrossRef
Metadata
Title
Individual participant data pooled-analysis of risk factors for recurrence after neoadjuvant radiotherapy and transanal local excision of rectal cancer: the PARTTLE study
Authors
A. Arezzo
G. Lo Secco
R. Passera
L. Esposito
M. Guerrieri
M. Ortenzi
K. Bujko
R. O. Perez
A. Habr-Gama
F. Stipa
M. Picchio
A. Restivo
L. Zorcolo
C. Coco
G. Rizzo
M. Mistrangelo
M. Morino
Publication date
01-09-2019
Publisher
Springer International Publishing
Published in
Techniques in Coloproctology / Issue 9/2019
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-019-02049-z

Other articles of this Issue 9/2019

Techniques in Coloproctology 9/2019 Go to the issue

Original Article

Pelvic fat volume reduction with preoperative very low energy diet (VLED): implications for rectal cancer surgery in the obese

Original Article

Innovative appliance for colostomy patients: an interventional prospective pilot study

Review

Cesarean delivery to prevent anal incontinence: a systematic review and meta-analysis

Correspondence

FiLaC™ as a last, sphincter-preserving resort for complex perianal fistula

Original Article

Transanal endoscopic microsurgery in very large and ultra large rectal neoplasia

Original Article

Long-term oncological results after transanal total mesorectal excision for rectal carcinoma