Sphincter‐saving surgery for ultra‐low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long‐term follow‐up?
In: Journal of Surgical Oncology, Jg. 123 (2020-10-24), S. 299-310
Online
unknown
Zugriff:
International audience; Background: Rate of abdominoperineal resection (APR) varies from countries and surgeons. Surgical impact of preoperative treatment for ultra-low rectal carcinoma (ULRC) initially indicated for APR is debated. We report the 10-year oncological results from a prospective controlled trial (GRECCAR 1) which evaluate the sphincter saving surgery (SSR).Methods: ULRC indicated for APR were included (n = 207). Randomization was between high-dose radiation (HDR, 45 + 18 Gy) and radiochemotherapy (RCT, 45 Gy + 5FU infusion). Surgical decision was based on tumour volume regression at surgery. SSR technique was standardized as mucosectomy (M) or partial (PISR)/complete (CISR) intersphincteric resection.Results: Overall SSR rate was 85% (72% ISR), postoperative morbidity 27%, with no mortality. There were no significant differences between the HDR and RCT groups: 10-year overall survival (OS10) 70.1% versus 69.4%, respectively, 10.2% local recurrence (9.2%/14.5%) and 27.6% metastases (32.4%/27.7%). OS and disease-free survival were significantly longer for SSR (72.2% and 60.1%, respectively) versus APR (54.7% and 38.3%). No difference in OS10 between surgical approaches (M 78.9%, PISR 75.5%, CISR 65.5%) or tumour location (low 64.8%, ultralow 76.7%).Conclusion: GRECCAR 1 demonstrates the feasibility of safely changing an initial APR indication into an SSR procedure according to the preoperative treatment tumour response. Long-term oncologic follow-up validates this attitude.
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Sphincter‐saving surgery for ultra‐low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long‐term follow‐up?
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Autor/in / Beteiligte Person: | Lemanski, C. ; Pezet, Denis ; Rouanet, Philippe ; Dravet, François ; Rullier, Eric ; Pocard, Marc ; Jean Luc Faucheron ; Gourgou, Sophie ; Jafari, Merhdad ; Mineur, Laurent ; Jean Michel Fabre ; Balosso, Jacques ; Lelong, Bernard ; Taoum, Christophe ; Bresler, Laurent ; Rivoire, Michel ; Institut du Cancer de Montpellier (ICM) ; Centre Léon Bérard [Lyon] ; Paoli-Calmettes, Institut ; Fédération nationale des Centres de lutte contre le Cancer (FNCLCC) ; CHU Bordeaux [Bordeaux] ; Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille) ; Université de Lille-UNICANCER ; Institut Sainte Catherine [Avignon] ; Service de Chirurgie d'Oncologie Digestive [CHU Lariboisière] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) ; Centre Hospitalier Universitaire [Grenoble] (CHU) ; Centre René Gauducheau ; CRLCC René Gauducheau ; Clermont-Ferrand, CHU ; Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier) ; Centre Hospitalier Universitaire de Nancy (CHU Nancy) |
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Zeitschrift: | Journal of Surgical Oncology, Jg. 123 (2020-10-24), S. 299-310 |
Veröffentlichung: | Wiley, 2020 |
Medientyp: | unknown |
ISSN: | 1096-9098 (print) ; 0022-4790 (print) |
DOI: | 10.1002/jso.26249 |
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