Organ preservation for rectal cancer (GRECCAR 2): a prospective, randomised, open-label, multicentre, phase 3 trial

Rullier, Éric; Rouanet, Philippe; Tuech, Jean‐Jacques; Valverde, A.; Lelong, Bernard; Rivoire, Michel; Faucheron, Jean‐Luc; Jafari, Mehrdad; Portier, G.; Meunier, Brigitte; Sileznieff, Igor; Prudhomme, Michel; Marchal, Frédéric; Pocard, Marc; Pezet, Denis; Rullier, Anne; Vendrely, V.; Denost, Quentin; Asselineau, Julien; Doussau, A.

doi:10.1016/s0140-6736(17)31056-5

Cited by 269 publications

(206 citation statements)

References 27 publications

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“…study which could have influenced the morbidity seen in the study. This is confirmed by the finding of the GRECCAR 2 trial where complementary TME following radiochemotherapy and TEM was associated with a significant major morbidity (46% vs 22%, P = 0.0031) .…”

Section: Discussionsupporting

confidence: 65%

Does transanal local resection increase morbidity for subsequent total mesorectal excision for early rectal cancer?

et al. 2018

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Aim Local excision is recommended for early rectal cancer (pT1). Complementary total mesorectal excision (cTME) is warranted when bad pathological features are present. The impact of a prior local resection on the outcome remains unclear. The aim of this study was to assess if prior local excision increases the morbidity of a subsequent cTME compared with primary TME. Methods From 2001 to 2016 all patients who underwent TME after local excision for rectal adenocarcinoma were studied. All were matched (1:1) with patients who underwent primary TME, without neoadjuvant radiochemotherapy. The matching factors included age, sex, body mass index, American Society of Anesthesiologists score and type of surgery. Short‐term morbidity and pathological examination of the resected specimen were compared. Results Forty‐one patients were included (14 women, 34%, mean age 65 ± 11 years), comprising classic transanal excision (66%) and transanal endoscopic microsurgery (34%), and were matched to 41 patients who had primary TME. cTME was significantly longer (315 min ± 87 vs 275 min ± 58, P = 0.03). The overall morbidity was 48.8% in the local excision group vs 31.7% in the control group (P = 0.18). Surgical morbidity was 31.7% vs 26.8% (P = 0.8). Anastomotic related morbidity was similar (local excision 17% vs TME 14.6%, P = 0.84) and the mean length of stay was similar (14 days) in both groups. There was a tendency to a worse quality of mesorectal excision in the cTME group (17% vs 5%, P = 0.15). Conclusion Local excision prior to TME for early rectal cancer tends to increase overall morbidity and may worsen the quality of the mesorectal plane but should be considered as a surgical approach in select cases.

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Section: Discussionsupporting

confidence: 65%

Does transanal local resection increase morbidity for subsequent total mesorectal excision for early rectal cancer?

et al. 2018

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“…The current standard operation is total mesorectal excision (TME). However, recent studies have investigated whether less aggressive management, such as organ‐preserving local transanal excision (TAE) or a watch‐and‐wait approach, could be used as an alternative without compromising patient survival when the patient has had a good response to CRT. High‐resolution rectal MRI is one of the most useful imaging tests for evaluating the response to CRT.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance tumour regression grade and pathological correlates in patients with rectal cancer

Jang

Lee

Park

et al. 2018

British Journal of Surgery

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“…The trial failed to show the superiority of local excision over TME, which was mainly due to the 26 of 74 patients in the local excision arm who required completion TME. In a post hoc analysis major morbidity and side effects occurred in 78% of patients who underwent completion TME after local excision compared with 38% in the TME arm [11]. While the trial confirmed favorable failure and organ preservation rates reported before in the CARTS and ACOSOG Z6041, GRECCAR-2 trial underlines the importance of accurate restaging after radiochemotherapy in order to prevent major morbidity due to completion surgery [21, 22].…”

Section: Is Limited Surgery An Option?mentioning

confidence: 90%

“…For instance, a patient with early distal rectal cancer (stage cT2 cN0 cM0) that would require abdominoperineal resection (APR) has a reasonable chance to achieve a cCR but also the highest risk of overtreatment when radiotherapy is applied with the goal of organ preservation, since an indication for preoperative treatment is not given based on tumor stage [10, 11]. At the same time the patient in this scenario has the highest potential gain if a cCR is achieved and maintained.…”

Section: “Planned” Organ Preservation or “Incidental” Ccr?mentioning

confidence: 99%

Watchful Waiting after Radiochemotherapy in Rectal Cancer: When Is It Feasible?

2019

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A “watch and wait” strategy in rectal cancer is increasingly considered in patients who achieve an excellent response to radiotherapy. While a growing number of studies have shown the feasibility of this strategy in selected patients, the optimal therapeutic regimen to maximize response rates still needs to be established. Furthermore, accurate response prediction and the management of minor residual findings after radiotherapy remain a matter of debate. Finally, concerns regarding the long-term oncological safety of the “watch and wait” approach have been expressed. Therefore, the present review aims to address the open questions in the context of a “watch and wait” strategy and focuses on the diagnosis of a clinical complete response and the ideal management thereafter.

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Organ preservation for rectal cancer (GRECCAR 2): a prospective, randomised, open-label, multicentre, phase 3 trial

Cited by 269 publications

References 27 publications

Does transanal local resection increase morbidity for subsequent total mesorectal excision for early rectal cancer?

Does transanal local resection increase morbidity for subsequent total mesorectal excision for early rectal cancer?

Magnetic resonance tumour regression grade and pathological correlates in patients with rectal cancer

Watchful Waiting after Radiochemotherapy in Rectal Cancer: When Is It Feasible?

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