Local excision after preoperative chemoradiation for T2 and T3 rectal cancers: is the wait over?
Mené sur 145 patients atteints d'un cancer du bas rectum de stade T2-T3 (durée médiane de suivi : 60 mois), cet essai multicentrique compare l'efficacité, du point de vue de la récidive locale, de la survie sans maladie et de la survie globale à 5 ans, d'une exérèse mésorectale totale et d'un traitement conservateur comportant une chimioradiothérapie et une exérèse locale
Radical resection of rectal cancer carries considerable morbidity, such as low anterior resection syndrome, sexual and urinary dysfunction, and stoma formation, which can affect quality of life. To reduce this impact, organ-preserving strategies have been developed. The watch-and-wait approach entails strict surveillance of selected patients who show complete clinical response after neoadjuvant treatment. Favourable outcomes have been shown; 1
however, watch and wait has yet to be assessed in a randomised clinical trial. Local excision is an alternative for patients who are downstaged after chemoradiotherapy. In the GRECCAR 2 trial, 2
patients with T2T3N0–1 rectal cancers with a maximum size of 4 cm and with good clinical response 6–8 weeks after neoadjuvant chemoradiotherapy were randomly assigned to receive local excision or radical surgery. In the local excision group, patients with ypT2–3 tumours or R1 resections had completion radical resection; those with ypT0–1 tumours were considered to be definitively treated. Early results of this superiority trial did not find differences between groups in a composite outcome of death, recurrence, morbidity, and side-effects.
The Lancet Gastroenterology & Hepatology , commentaire, 2019