Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 19:11:1448073.
doi: 10.3389/fsurg.2024.1448073. eCollection 2024.

Total neoadjuvant therapy followed by total mesorectal excision for rectal cancer in older patients real world data and proof of concept

Isacco Montroni  1 , Francesca Di Candido  2 , Giovanni Taffurelli  1 , Stefano Tamberi  3   4 , Elisa Grassi  4 , Jody Corbelli  3 , Floranna Mauro  5 , Enrico Raggi  5 , Anna Garutti  4 , Giampaolo Ugolini  1   6
Affiliations

Total neoadjuvant therapy followed by total mesorectal excision for rectal cancer in older patients real world data and proof of concept

Isacco Montroni et al. Front Surg. .

Abstract

Background: Rectal cancer (RC) commonly affects older patients. Total Neoadjuvant Therapy (TNT) has been introduced to improve local and systemic control of RC. The aim was to present real-world data of older patients receiving TNT followed by surgery after a frailty assessment and verify feasibility and safety of this approach.

Methods: This was a single-center retrospective study which enrolled all patients ≥70 years of age with RC who underwent TNT followed by surgery between November 2017 and April 2022. Data regarding cancer characteristics, neoadjuvant chemoradiotherapy (CRT), and toxicity were recorded. All patients underwent surgery 12-16 weeks after the end of therapy. Intra- and postoperative outcomes were recorded. Pre- and postoperative functional evaluation was carried out.

Results: Fifteen patients were enrolled. Mean age was 74 (70-81) years. Mean distance of the tumor from the anal verge was 5.2 cm. Fourteen patients had positive nodes (93.3%), 11 (73.3%) showed involvement of the circumferential margin (CRM+) and 10 (66.6%) had extramural vascular invasion (EMVI+). Ten patients (66.6%) received mFOLFOX-6 and 5 CAPOX (33.3%) followed by CRT. After CRT, positive nodes were reported in 4 cases (26.6%), CRM+ in 4 (26.6%), and EMVI+ in 1 (6.6%). Transanal total mesorectal excision (taTME) was performed in all cases. Median operative time was 280 min (110-420). Median length of stay was 4 days (3-29). One Clavien-Dindo grade 4 complication, no readmissions, and no variations in pre- and postoperative functional status within 30 days from surgery were reported. No positive distal or CRMs were detected. Three pathologic complete responses were reported (20%).

Conclusions: TNT followed by TME is feasible and safe in older patients, with good clinical and oncologic outcomes. Patient evaluation is crucial for maximizing cancer care in fit older patients.

Keywords: elderly; functional recovery; neoadjuvant therapy; rectal cancer; transanal total mesorectal excision.

PubMed Disclaimer

Conflict of interest statement

IM is faculty and invited speaker at Olympus SE Rectal cancer and minimally invasive surgery courses. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. (2018) 68(6):394–424. Erratum in: CA Cancer J Clin. 2020 70(4):313. 10.3322/caac.21492 - DOI - PubMed
    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. (2021) 71(3):209–49. 10.3322/caac.21660 - DOI - PubMed
    1. Rutten HJ, den Dulk M, Lemmens VE, van de Velde CJ, Marijnen CA. Controversies of total mesorectal excision for rectal cancer in elderly patients. Lancet Oncol. (2008) 9(5):494–501. 10.1016/S1470-2045(08)70129-3 - DOI - PubMed
    1. Birch RJ, Taylor JC, Downing A, Spencer K, Finan PJ, Audisio RA, et al. Rectal cancer in old age -is it appropriately managed? Evidence from population-based analysis of routine data across the English National Health Service. Eur J Surg Oncol. (2019) 45(7):1196–204. 10.1016/j.ejso.2019.01.005 - DOI - PMC - PubMed
    1. De Angelis R, Sant M, Coleman MP, Francisci S, Baili P, Pierannunzio D, et al. Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5-a population-based study. Lancet Oncol. (2014) 15(1):23–34. 10.1016/S1470-2045(13)70546-1 - DOI - PubMed

LinkOut - more resources