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Title
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Is watch and wait a safe and effective way to treat rectal cancer in older patients?
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Author
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Institution/Organisation
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Dutch Watch-and-Wait Consortium
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Abstract
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| Introduction The aim was assess the oncological and functional outcome of the watch-and-wait (W&W) approach in older patients with a clinical (near)complete response after neoadjuvant treatment for rectal cancer. Material and methods Patients were included in a W&W-approach (2004–2019) when digital rectal examination, endoscopy and MRI showed a (near)clinical complete response. Patients underwent endoscopy and MRI every 3 months during the first year, and 6-monthly thereafter. Patients aged ≥75 and ≥ 2 years of follow-up (FU) were selected. Oncological outcomes were assessed with Kaplan-Meier curves. Functional outcome was assessed with colostomy-free rate, Vaizey incontinence score, low anterior resection syndrome-score and International Prostate Syndrome Score. Results 43/304 (14%) of patients in a W&W-approach met the inclusion criteria. Median FU was 37 (24–109) months. 5/43(12%) developed a local regrowth. All were treated surgically, with one patient experiencing a pelvic failure. Distant metastases occurred in 3/43 patients and 4 patients died, 3 of whom not related to rectal cancer. The 3-year local regrowth-free rate was 88%, 3-year non-regrowth disease-free survival 91%, overall survival 97% and 3-year colostomy-free rate 93%. Overall, the bowel- and urinary dysfunction scores at 3, 12 and 24 months indicated good continence, no or minor LARS and moderate urinary problems. Conclusion W&W for older patients with a clinical (near) complete response appears to be a safe alternative to a total mesorectal excision (TME), with a very high pelvic control rate, and few rectal cancer related deaths. Most patients can avoid major surgery and a definitive colostomy, and have a reasonable anorectal and urinary function. |
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Language
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English
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Source (journal)
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European journal of surgical oncology. - London
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Publication
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London
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2020
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ISSN
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0748-7983
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DOI
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10.1016/J.EJSO.2020.01.005
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Volume/pages
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46
:3
(2020)
, p. 358-362
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ISI
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000527361500012
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Pubmed ID
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31982206
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Full text (Publisher's DOI)
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Full text (publisher's version - intranet only)
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