Risks of Organ Preservation in Rectal Cancer: Data From Two International Registries on Rectal Cancer
Authors: Laura M. Fernandez, Guilherme P. São Julião, Carlos Cerdan Santacruz, Andrew G. Renehan, Oscar Cano-Valderrama, Geerard L. Beets, Jose Azevedo, Blas F. Lorente, Rocío S. Rancaño, Sebastiano Biondo, Eloy Espin-Basany, Bruna B. Vailati, Per J. Nilsson, Anna Martling, Cornelis J.H. Van De Velde, Amjad Parvaiz, Angelita Habr-Gama, Rodrigo O. Perez, Francisco Blanco Antona, Elena Yagüe Martín, Jesús Cifuentes Tébar, Alberto Parajó Calvo, Natalia Uribe Quintana, Mauricio García Alonso, Jesús Paredes Cotoré, Ana Benítez Riesco, Noelia Ibañez Cánovas, Camen Martinez Sanchez, Didac Ribe i Serrat, Guillermo Ais, Marta Jiménez Toscano, Antonio Climent, Monica Reig Pérez, José Enrique Sierra Grañón, Janire Mateo, Sebastiano Biondo, Ana Gálvez Saldaña, Carlos Álvarez Laso, Ignacio Aguirre Allende, Daniel Huerga Álvarez, Ramón Farrés Coll, Wilson M. Sánchez Bautista, Maria Teresa Torres Sánchez, Paula Dujovne, Ignasi Camps, Marta Cuadrado, Olga Maseda Díaz, Nieves Sánchez, Maria del Coral de la Vega Olías, Eloy Espin Basan, Miquel Kraft Carre, Mahdi Aghili, Marion Arnold, Oktar Asoglu, Krzysztof Bujko, André Caiado, Carlos Carvalho, Ronald Chautems, Claudio Coco, Giuditta Chiloiro, Chris Cunningham, Petra Custers, Hester Haak, André D'Hoore, Gabriel Dimofte, Peirong Ding, S. Duff, Natalia Felicio, Nuno Figueiredo, Wolfgang Gaertner, Jean-Pierre Gérard, Joaquim Gama-Rodrigues, Barbara Geubels, Ellen Gregory, Ivana P. Salazar, Ignacio Herrando, J. Hill, Z. Huq, Frederique Jacquinot, Anders Jakobsen, Lars Henrik Jensen, D. Jones, Amir Keshvari, Stijn H.J. Ketelaers, U. Khan, R. Kushwaha, Shahrzad Kordnejad, Kurt Leitner, Robert Madoff, Lee Malcomson, Anna Martling, Katja Fechner, Klaus E. Matzel, Claudia Mazzarisi, Elma Meershoek, Jarno Melenhorst, Mohammed Nouritaromlou, Goffredo Paolo, Alexander Pennings, Sthela M. Murad-Regadas, Rafael Pandini, Koen C.M.J. Peeters, S. Rawat, D. Richards, Isadora Rosa, Gustavo Rossi, Harm J.T. Rutten, Fernando Sanchez Loria, Ines Santiago, K.H. Siddiqui, M.H. Solkar, Arthur Sun Myint, K. Telford, J. Tang, Sofieke Temmink, Handan Tokmak, Carlos A. Vaccaro, S. Ward, Albert M. Wolthuis, Lameris Wytze, Jiehai Yu, Zhen Zhang
Journal: Journal of Clinical Oncology (2024)

PURPOSE Organ preservation has become an attractive alternative to surgery (total mesorectal excision [TME]) among patients with rectal cancer after neoadjuvant therapy who achieve a clinical complete response (cCR). Nearly 30% of these patients will develop local regrowth (LR). Although salvage resection is frequently feasible, there may be an increased risk for development of subsequent distant metastases (DM). The aim of this study is to compare the risk of DM between patients with LR after Watch and Wait (WW) and patients with near-complete pathologic response (nPCR) managed by TME at the time of reassessment of response. METHODS Data from patients enrolled in the International Watch &amp; Wait Database (IWWD) with cCR managed by WW and subsequent LR were compared with patients managed by TME (with ≤10% cancer cells—nPCR) from the Spanish Rectal Cancer Project (VIKINGO project). The primary end point was DM-free survival at 3 years from decision to WW or TME. The secondary end point was possible risk factors associated with DM. RESULTS Five hundred and eight patients with LR were compared with 893 patients with near-complete response after TME. Overall, DM rate was significantly higher among LRs (22.8% v 10.2%; P ≤ .001). Independent risk factors for DM included LR ( v TME at reassessment; P = .001), ypT3-4 status ( P = .016), and ypN+ status ( P = .001) at the time of surgery. 3-year DM-free survival was significantly worse for patients with LR (75% v 87%; P = .001). When stratified for pathologic stage, patients with LR did significantly worse through all stages ( P ≤ .009). CONCLUSION Patients with LR appear to have a higher risk for subsequent DM development than patients with nPCR managed by TME at restaging irrespective of final pathology. Leaving the primary undetectable tumor in situ until development of LR may result in worse oncologic outcomes.