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01-11-2007

Local Excision for ypT2 Rectal Cancer—Much Ado About Something

Authors: Rodrigo O. Perez, Angelita Habr-Gama, Igor Proscurshim, Fábio G. Campos, Desiderio Kiss, Joaquim Gama-Rodrigues, Ivan Cecconello

Published in: Journal of Gastrointestinal Surgery | Issue 11/2007

Abstract

Background

The role of local excision for pT2 distal rectal cancer has been challenged because of the observation of high rates of lymph node metastases and local failure. However, neoadjuvant chemoradiation therapy (CRT) has led to increased local disease control and significant tumor downstaging, possibly decreasing rates of lymph node metastases. In this setting, a possible role for local excision of ypT2 has been suggested.

Methods

A total of 401 patients with distal rectal cancer underwent neoadjuvant CRT. Tumor response assessment was performed after at least 8 weeks from CRT completion. One hundred and twelve patients with complete clinical response were not immediately operated on and were excluded from the study, and 289 patients with incomplete clinical response were managed by radical surgery. Patients with final pathological stage ypT2 were analyzed to determine the risk of unfavorable pathological features that could represent unacceptable risk for local failure after local excision.

Results

Eighty-eight (30%) patients had ypT2 rectal cancer. Final ypT status was not associated with pretreatment radiological staging (p = 0.62). ypT status was significantly associated with the risk of lymph node metastases, risk of perineural and vascular invasion, and recurrence (p = 0.001). Lymph node metastases were present in 19% of patients with ypT2 rectal cancer. The risk of lymph node metastases in ypT2 was associated with the presence of perineural invasion (47% vs 4%; p = <0.001), vascular invasion (59% vs 6%; p < 0.001), and decreased mean interval CRT surgery (12 vs 18 weeks; p < 0.001), but not with mean tumor size (3.2 vs 3.1 cm; p = 0.8). Disease-free and overall survival rates were significantly better for patients with ypT2N0 (p = 0.02 and 0.006, respectively). Fifty-five (63%) patients with ypT2 had at least one unfavorable pathological feature for local excision (lymph node metastases, vascular or perineural invasion, mucinous type or tumor size >3 cm).

Conclusion

Lymph node metastases were present in 19% of patients with ypT2 and were significantly associated with poor overall and disease-free survival rates. The risk of lymph node metastases could not be predicted by radiological staging or tumor size. Radical surgery should be considered the standard treatment option for ypT2 rectal cancer after CRT.

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Title: Local Excision for ypT2 Rectal Cancer—Much Ado About Something
Authors: Rodrigo O. Perez
Angelita Habr-Gama
Igor Proscurshim
Fábio G. Campos
Desiderio Kiss
Joaquim Gama-Rodrigues
Ivan Cecconello
Publication date: 01-11-2007
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 11/2007
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-007-0271-3

2024 ASCO Annual Meeting

Springer Medicine

Local Excision for ypT2 Rectal Cancer—Much Ado About Something

Abstract

Background

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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