Long-term results of local excision for rectal cancer for those with complete rectal wall response following neoadjuvant therapy: OP54

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Aim:Neoadjuvant chemoradiation (NC) for advanced rectal cancer has improved local disease control. Complete rectal wall tumour regression may be associated with the absence of viable cancer cells in the mesorectum, and thus local excision (LE) of such lesions as an alternative to radical surgery has gained interest recently. We report the outcome of (LE) in patients with a mural pathological complete response after (NC).Method:A retrospective review of patients after (NC) and (LE) for rectal cancer who were found to have no residual tumour in the resected specimen between 1998 and 2008 was performed.Results:There were 23 patients, 12 men and 11 women, with median age of 66.3. Thepretreatment stage was T3N1in 4 (17%), T3N0 in 11 (47%), and 4 (17%) had T2N1, and 4 (17%) had T2N0. The median tumour distance from the anal verge was 6.2 cm. Sixteen (70%) underwent transanal excision and 7 (30%) had Transanal-Endoscopic-Microsurgery. The median follow-up was 86 months. Four developed other malignancies, three of them died of metastasis. No recurrences were observed at current follow-up.Conclusion:Although radical rectal resection is the treatment of choice, (LE) of those with complete rectal tumour regression could be a safe alternative with a acceptable results in selected patients.

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