title: Locally advanced rectal cancer: Preliminary results of rectal preservation after neoadjuvant chemoradiotherapy.
abstract: BACKGROUND
  The standard treatment for locally advanced rectal cancer is total mesorectal excision. However, organ preservation has been proposed for tumors with good response to neoadjuvant treatment. The aim of this study was to evaluate the oncologic results of this strategy.
  
  
  METHODS
  This is a retrospective cohort study (2005-2014) including a consecutive series of patients with rectal adenocarcinoma with complete or almost complete clinical response after preoperative chemo-radiotherapy, that were treated according to a strategy of preservation of the rectum.
  
  
  RESULTS
  A total of 204 patients with rectal cancer received neoadjuvant therapy. Thirty (14.7%) had a good response and were treated with rectal preservation (23 «Watch and Wait» and 7 local resections). Median follow-up was 46 months (interquartile range: 30-68). In the group of «Watch & Wait», 4 patients had local recurrence before 12 months (actuarial local recurrence rate=18.5%). All of them underwent salvage surgery (2 with radical surgery and 2 local resections) without any further recurrence. Disease-free survival actuarial rate at 3 years follow-up was 94.1% (95% CI 82.9-100). None of the 7 patients that were treated by local excision had local recurrence. The organ preservation rate for the whole group was 93%.
  
  
  CONCLUSIONS
  The strategy of organ preservation in locally advanced rectal cancer is feasible in cases with good response to neoadjuvant therapy. When implemented in a highly selected group of patients this strategy is associated with satisfactory oncologic results.
authors.affiliation: Servicio Cirugía General, Sector de Coloproctología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. Electronic address: carlos.vaccaro@hospitalitaliano.org.ar.
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Vaccaro
authors.affiliation: Servicio Cirugía General, Sector de Coloproctología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Federico Julio
authors.initials: FJ
authors.lastname: Yazyi
authors.affiliation: Servicio Cirugía General, Sector de Coloproctología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ojra Quintana
authors.affiliation: Servicio Anatomía Patológica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Santino
authors.affiliation: Servicio Oncología Radiante, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Mabel Edith
authors.initials: ME
authors.lastname: Sardi
authors.affiliation: Servicio Cirugía General, Sector de Coloproctología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Damián
authors.initials: D
authors.lastname: Beder
authors.affiliation: Servicio Cirugía General, Sector de Coloproctología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Tognelli
authors.affiliation: Servicio Cirugía General, Sector de Coloproctología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Bonadeo
authors.affiliation: Servicio Oncología Radiante, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: José María
authors.initials: JM
authors.lastname: Lastiri
authors.affiliation: Servicio Cirugía General, Sector de Coloproctología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Gustavo Leandro
authors.initials: GL
authors.lastname: Rossi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000368:Aged; D059248:Chemoradiotherapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Complete clinical response; Conservative treatment; Cáncer de recto; Local resection; Neoadjuvant; Neoadyuvancia; Rectal cancer; Resección local; Respuesta clínica completa; Tratamiento conservador; Watch and wait; «Watch and wait»