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. 2024 Aug 27;16(8):e67955.
doi: 10.7759/cureus.67955. eCollection 2024 Aug.

Outcomes of Watch-and-Wait Versus Abdominoperineal Resection in Lower Rectal Adenocarcinoma Post Neoadjuvant Therapy: An Iraqi Cohort Study

Aqeel S Mahmood  1 , Osama Jalal Fakhir  2 , Haider A Ahmed  3 , Manwar Abdulelah Alnaqqash  4 , Tahseen Alrubaei  2 , Wieeam Abdulfattah Saleh  2 , Ahmed A Alkadir  2 , Ahmed Zuhair Alsammarraie  2 , Forat Yahya Mohsin  2 , Ahmed A Shakir  5 , Yesor Jamal Albadri  2 , Mustafa Ismail  6
Affiliations

Outcomes of Watch-and-Wait Versus Abdominoperineal Resection in Lower Rectal Adenocarcinoma Post Neoadjuvant Therapy: An Iraqi Cohort Study

Aqeel S Mahmood et al. Cureus. .

Abstract

Background: Rectal malignancy ranks among the most prevalent malignancies in humans. Neoadjuvant chemoradiotherapy (nCRT) is advocated as the standard treatment for locally advanced rectal cancer. In patients who achieve complete clinical response (cCR), successive surgical intervention may result in favorable immediate and long-lasting results; however, it may be associated with decreased quality of life. This study aims to evaluate the incidence of local recurrence in rectal adenocarcinoma between patients who underwent a watch-and-wait approach and those who underwent abdominoperineal resection following the achievement of a cCR after nCRT.

Methods: This is an analytic cohort study that included 68 patients and was conducted in Baghdad Teaching Hospital/Medical City, Baghdad. The data were collected from the 1st of April 2021 to the 1st of October 2023. All patients with stage II and III rectal adenocarcinoma who achieved cCR after receiving nCRT were included in the study.

Results: There was no statistically significant difference between the two study groups regarding non-regrowth disease-free survival (p-value = 0.708). Cox-regression multivariate analysis revealed that baseline T stage and serum carcinoembryonic antigen (CEA) were significantly associated with locoregional failure.

Conclusion: The present study reveals that implementing the watch-and-wait strategy had the benefit of avoiding major surgery, stoma, and their complications without coming at the cost of reduced locoregional recurrence.

Keywords: abdominoperineal resection; colorectal adenocarcinoma; complete clinical response; neoadjuvant chemoradiotherapy; watch-and-wait.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Iraqi Board for Medical Specializations issued approval 1053. Verbal and written consent has been obtained from all participants before data collection. An official letter of approval has been obtained from the Scientific Committee of the Scientific Council of General Surgery – Iraqi Board for Medical Specializations. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Distribution of patients according to the treatment approach.
Figure 2
Figure 2. Non-regrowth disease-free survival of both study groups.
See this image and copyright information in PMC

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