Preoperative T3 and T2N+ rectal cancer: is neoadjuvant therapy always necessary?: P100


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Abstract

Aim:To assess factorspredicting recurrence in rectal cancer patients withpreoperative stage cT2N+ or cT3N0/+, treated with total mesorectal excision (TME) withoutpreoperative chemo-radiotherapy (pCRT).Method:This is a consecutive series of 152 rectal cancer patientspreoperatively staged as cT2N+ or cT3, who underwent TME without pCRT (period 1997-2008). Factors potentially related to local recurrence (LR), disease free survival (DFS) and overall survival (OS) were analyzed.Results:Median follow-up was 39 months. Overall, 5-year actuarial rate for LR, DFS and OS were 9.5%, 65.4% and 77.8% respectively. Preoperative threatened circumferential resection margin (CRM ≤ 2 mm) was observed in 18 patients and was the most powerful singlepreoperative factor topredict a higher LR (P = 0.007), shorter DFS (P = 0.007) and OS (P = 0.05). In particular, 5-year LR rate in patients with or withoutpreoperative threatened CRM was 19.4% and 5.4% respectively. Other factors such aspreoperative N+ or location of the tumour did notpredict the risk of LR.Conclusion:Our study suggests that rectal cancer patientspreoperatively staged as T3N0/+ or T2N+ with a free CRM could be treated with TME alone, avoiding overtreatment with pCRT.

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