Abstract 246P
Background
Total neoadjuvant therapy (TNT) demonstrates significant improvement of primary rectal cancer treatment results. However, applying laparoscopic approach for this category of patients still raises controversies.
Methods
A single-center randomized two-arm study of 110 patients with locally advanced mrf+ rectal cancer was performed. All patients were administered with induction 50,4Gy chemoradiation therapy followed by 12 weeks of CapOX chemotherapy. Eligible patients were randomized prior to surgery in the study arm (laparoscopic TME) and control arm (open TME). Immediate treatment outcomes, quality of mesorectal excision and rates of R0 resection were assessed.
Results
Both groups had significant responses to TNT (mrTRG 1-3 and RECIST 1-2). It was more pronounced in patients of the main group 59.7% versus 57.2%. The frequency of conversion of mrf+ status to mrf- was 68.4% and 55.3% in the study and control arm respectively. All patients underwent curative surgery. In the control arm the quality of TME was estimated as satisfactory in all cases and all surgical interventions were histologically confirmed as R0. Histopathological examination revealed a threatened circular resection margin in 2 patients of the main group (4%) and 5 (10%) of the control group. The mean number of removed and metastatic lymph nodes was not statistically different in both groups. There were no cases of postoperative mortality in both groups. The incidence of postoperative complications was comparable in both groups and did not differ statistically. There was a greater number of postoperative complications in the control arm, mainly due to postoperative wound site infection. For patients in the main group postoperative recovery period was 8.4 ± 2.6 days, for the study arm - 5.8 ± 2.2 postoperative days.
Conclusions
Laparoscopic TME in patients with locally advanced distal rectal cancer after total neoadjuvant therapy has demonstrated its safety in terms of immediate outcomes, mesorectal excision quality and rates of R0 resections. Laparoscopic TME can be safely performed to those who achieved sufficient tumor downsizing and downstaging.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.