BACKGROUND: Nonoperative management for patients with rectal cancer who have achieved a clinical complete response after chemoradiotherapy is becoming increasingly important in recent years. However, the definition of and modality used for patients with clinical complete response differ greatly between institutions, and the role of endoscopic assessment as a nonoperative approach has not been fully investigated. OBJECTIVE: This study aimed to investigate the ability of endoscopic assessments to predict pathological regression of rectal cancer after chemoradiotherapy and the applicability of these assessments for the watchful waiting approach. DESIGN: This was a retrospective comparative study. SETTINGS: This study was conducted at a single referral hospital. PATIENTS: A total of 198 patients with rectal cancer underwent preoperative endoscopic assessments after chemoradiotherapy. Of them, 186 patients underwent radical surgery with lymph node dissection. MAIN OUTCOME MEASURES: The histopathological findings of resected tissues were compared with the preoperative endoscopic findings. Twelve patients refused radical surgery and chose watchful waiting; their outcomes were compared with the outcomes of patients who underwent radical surgery. RESULTS: The endoscopic criteria correlated well with tumor regression grading. The sensitivity and specificity for a pathological complete response were 65.0% to 87.1% and 39.1% to 78.3%. However, endoscopic assessment could not fully discriminate pathological complete responses, and the outcomes of patients who underwent watchful waiting were considerably poorer than the patients who underwent radical surgery. Eventually, 41.7% of the patients who underwent watchful waiting experienced uncontrollable local failure, and many of these occurrences were observed more than 3 years after chemoradiotherapy. LIMITATIONS: The number of the patients treated with the watchful waiting strategy was limited, and the selection was not randomized. CONCLUSIONS: Although endoscopic assessment after chemoradiotherapy correlated with pathological response, it is unsuitable for surveillance of patients treated via a nonoperative approach. Incorporation of a "watchful waiting" strategy without establishing proper surveillance protocols and salvage strategies might result in poor local control.
BACKGROUND: Nonoperative management for patients with rectal cancer who have achieved a clinical complete response after chemoradiotherapy is becoming increasingly important in recent years. However, the definition of and modality used for patients with clinical complete response differ greatly between institutions, and the role of endoscopic assessment as a nonoperative approach has not been fully investigated. OBJECTIVE: This study aimed to investigate the ability of endoscopic assessments to predict pathological regression of rectal cancer after chemoradiotherapy and the applicability of these assessments for the watchful waiting approach. DESIGN: This was a retrospective comparative study. SETTINGS: This study was conducted at a single referral hospital. PATIENTS: A total of 198 patients with rectal cancer underwent preoperative endoscopic assessments after chemoradiotherapy. Of them, 186 patients underwent radical surgery with lymph node dissection. MAIN OUTCOME MEASURES: The histopathological findings of resected tissues were compared with the preoperative endoscopic findings. Twelve patients refused radical surgery and chose watchful waiting; their outcomes were compared with the outcomes of patients who underwent radical surgery. RESULTS: The endoscopic criteria correlated well with tumor regression grading. The sensitivity and specificity for a pathological complete response were 65.0% to 87.1% and 39.1% to 78.3%. However, endoscopic assessment could not fully discriminate pathological complete responses, and the outcomes of patients who underwent watchful waiting were considerably poorer than the patients who underwent radical surgery. Eventually, 41.7% of the patients who underwent watchful waiting experienced uncontrollable local failure, and many of these occurrences were observed more than 3 years after chemoradiotherapy. LIMITATIONS: The number of the patients treated with the watchful waiting strategy was limited, and the selection was not randomized. CONCLUSIONS: Although endoscopic assessment after chemoradiotherapy correlated with pathological response, it is unsuitable for surveillance of patients treated via a nonoperative approach. Incorporation of a "watchful waiting" strategy without establishing proper surveillance protocols and salvage strategies might result in poor local control.
Authors: Jin K Kim; Hannah Thompson; Rosa M Jimenez-Rodriguez; Fan Wu; Francisco Sanchez-Vega; Garrett M Nash; Jose G Guillem; Philip B Paty; Iris H Wei; Emmanouil P Pappou; Maria Widmar; Martin R Weiser; J Joshua Smith; Julio Garcia-Aguilar Journal: Ann Surg Oncol Date: 2021-10-03 Impact factor: 5.344
Authors: Jan Marie de Gooyer; Fortuné M K Elekonawo; Andreas J A Bremers; Otto C Boerman; Erik H J G Aarntzen; Philip R de Reuver; Iris D Nagtegaal; Mark Rijpkema; Johannes H W de Wilt Journal: Nat Commun Date: 2022-05-12 Impact factor: 17.694
Authors: Sungwoo Jung; Anuj Parajuli; Chang Sik Yu; Seong Ho Park; Jong Seok Lee; Ah Young Kim; Jong Lyul Lee; Chan Wook Kim; Yong Sik Yoon; In Ja Park; Seok-Byung Lim; Jin Cheon Kim Journal: Ann Coloproctol Date: 2019-10-31
Authors: Mariana F Coraglio; Martin A Eleta; Mirta R Kujaruk; Javier H Oviedo; Enrique L Roca; Guillermo A Masciangioli; Guillermo Mendez; Ilma S Iseas Journal: World J Surg Oncol Date: 2020-11-30 Impact factor: 2.754
Authors: Fernando López-Campos; Margarita Martín-Martín; Roberto Fornell-Pérez; Juan Carlos García-Pérez; Javier Die-Trill; Raquel Fuentes-Mateos; Sergio López-Durán; José Domínguez-Rullán; Reyes Ferreiro; Alejandro Riquelme-Oliveira; Asunción Hervás-Morón; Felipe Couñago Journal: World J Gastroenterol Date: 2020-08-07 Impact factor: 5.742