Controversias en la Resección local del cáncer de recto Estadio I

Angel M.  Minetti; Ignacio  Pitaco; Juan Pablo   Santilli; Ignacio  Ramallo; Facundo Sebastian Carrasco

doi:10.46768/racp.v35i2.266

Angel M. Minetti Sanatorio Trinidad de Quilmes https://orcid.org/0000-0003-1235-6904
Ignacio Pitaco https://orcid.org/0000-0002-8450-0488
Juan Pablo Santilli https://orcid.org/0000-0001-8165-2171
Ignacio Ramallo https://orcid.org/0000-0001-5139-3586
Facundo Sebastian Carrasco 1161879674 https://orcid.org/0000-0002-4193-9562

DOI: https://doi.org/10.46768/racp.v35i2.266

Abstract

Introduction:

The standard treatment of rectal cancer in stages II and III is excision of the mesorectum together with neoadjuvant therapy. However, it can lead to undesirable functional sequelae.

There are studies showing that organ-sparing treatment is possible for T1 and T2 tumours without lymph node involvement, with similar results to radical treatments.

The aim of this study is to present the results of a series of patients treated by local resection at Stage I.

Material and Methods:

Presentation of 13 patients treated for rectal cancer with local resection between 2012 and 2021.

Results:

In 7 female patients, mean age 63.1 years, the location of lesions ranged from 2 to 8 cm (4.07) from the margin.

Location: posterior, 6; anterior, 4; anterolateral, 2; and posterolateral, 1.

Neoadjuvant therapy was performed in 3 patients at stage T2 and the final pathological outcome (ypt) was: T1 in 2 patients and complete pathological response in 1.

The final pathological outcome of the remaining 10 patients who had not received preoperative treatment was: T2, 2.; T1 sm1, 3 and T1 sm3, 5. Lymphovascular invasion was negative in 8 patients.

2 patients had complications (15.4%)

2 patients underwent radical resection, one because of inadequate margins and the other because of an unfavourable result in the resection specimen.

Follow-up at 54.5 months (12-120 m) ended with no evidence of local or distant recurrence in 12 patients; 1 patient died of carcinomatosis after 8 months

Conclusion:

The strategies currently used in the conservative treatment of rectal cancer are promising and should therefore be offered to patients in the context of a clinical trial with rigorous and secure records. The quality of the evidence to date is not sufficient to replace the current standard treatment.