背景:直肠癌新辅助长疗程放化疗(NLCRT)可导致完全病理反应(pCR)。2017年,我们开始提供具有完全临床反应(cCR)的患者,在全直肠系膜切除术(TME)和强化监测或“观察并等待”(W&W)计划之间进行选择。我们报告了这项前瞻性研究的早期结果。
方法:纳入2017年至2019年接受NLCRT的所有患者。所有患者在8周时再入院。那些有cCR的人被提供给TME或W&W。
结果:在59名接受NLCRT的患者中,55进行了重新分类。这些患者中有11例具有cCR(20%)。三个人选择了TME,并且都有pCR。8人在W&W注册。两名患者被诊断为局部再生,并在NLCRT后7和17个月接受了TME。还有9个病人,手术不适合或拒绝TME的人,对NLCRT反应很好,但是没有达到cCR的标准,也由W&W管理。其中,两名患者出现远处转移的再生.从2017年到2019年,在使用W&W方法管理的17名患者中,在W&W的中位数为28(13-58)个月后,有13例患者保持无再生。
结论:初步研究结果表明,使用W&W进行管理,在cCR之后,可能是TME的安全替代品。到目前为止,还没有发生过遥远的失败,那些有cCR的人有再生,被及早发现,并通过救助TME成功管理。
BACKGROUND: Neoadjuvant long course chemoradiotherapy (NLCRT) for rectal cancer can result in complete pathological response (pCR). In 2017, we started offering patients who had a complete clinical response (cCR), a choice between total mesorectal excision (TME) and an intensive surveillance or \'watch and wait\' (W&W) program. We report the early outcomes of this prospective study.
METHODS: All patients undergoing NLCRT from 2017 to 2019 were included. All patients were restaged at 8 weeks, and those who had a cCR were offered TME or W&W.
RESULTS: Of 59 patients who underwent NLCRT, 55 had restaging. Eleven of these patients had a cCR (20%). Three chose to have TME and all had a pCR. Eight were enrolled in W&W. Two patients were diagnosed with local regrowth and underwent TME at 7 and 17 months after NLCRT. A further nine patients, who were surgically unfit or refused TME, and had an excellent response to NLCRT, but one that did not reach criteria for a cCR, were also managed with W&W. Of these, two patients developed regrowth with distant metastases. From 2017 to 2019, of the 17 patients who were managed with a W&W approach, 13 patients have remained regrowth free after a median of 28 (13-58) months of W&W.
CONCLUSIONS: Preliminary findings suggest management with W&W, following cCR, may be a safe alternative to TME. There have so far been no instances of distant failure, and those with cCR that had regrowth, were identified early and successfully managed with salvage TME.