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The “Watch and Wait” Method After Chemoradiotherapy for Rectal Cancer Requiring Abdominoperineal Resection

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Abstract

The present study examined the therapeutic effects of preoperative neoadjuvant chemoradiation therapy (NACRT) and predictive factors for complete clinical remission, compared the prognosis and costs of abdominoperineal resection (APR) and the “watch and wait” method (WW), and evaluated the usefulness of WW. In our department, patients with stage II–III lower rectal cancer requiring APR receive NACRT. NACRT was performed as a preoperative treatment (52 Gy + S-1: 80–120 mg/day × 25 days). Eight weeks after the completion of NACRT, rectal examination, endoscopic, computed tomography, and magnetic resonance imaging findings were evaluated to assess its therapeutic effects. APR was indicated for patients in whom endoscopic findings suggested a residual tumor in which a deep ulcer or marginal swelling remained or lymph node metastasis. However, WW was selected for patients who refused APR after informed consent was obtained. In the APR and WW groups, 5- and 20-year treatment costs after CRT were calculated using the Medical Fee Points of Japan in 2020. No significant differences were observed in 3-year disease-free survival rates for either parameter between the two groups. Regarding expenses, treatment costs were lower in the WW group than in the APR group. Organ preservation using active surveillance with CRT for rectal cancer requiring APR is feasible with the achievement of endoluminal complete remission.

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Acknowledgements

We are grateful to Dr. Mihoko Nakagawa, Dr. Hiroaki Kobayashi, Dr. Kensuke Kakisako, Dr. Yojiro Takano, Dr .Junichi Seki, Dr. Kenta Nakahara, and Dr. Shoji Shimada for their collaborations in the early stages of this work.

We also would like to thank the Medical English Service (https://www.med-english.com) for English language editing.

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Authors and Affiliations

  1. Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1, Tsuzuki-Ku, Chigasakichuo, Yokohama City, Kanagawa, 224-8503, Japan

    Naruhiko Sawada, Shumpei Mukai, Yusuke Takehara, Masashi Misawa, Toyoki Kudo, Takemasa Hayashi, Kunihiko Wakamura, Yuta Enami, Hideyuki Miyachi, Toshiyuki Baba, Fumio Ishida & Shin-ei Kudo

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  1. Naruhiko Sawada
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  2. Shumpei Mukai
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Contributions

All authors contributed to the conception and design of the study. Material preparation and data collection and analyses were performed by NS and SM. The first draft of the manuscript was written by NS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Naruhiko Sawada.

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Ethical Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Showa University Northern Yokohama Hospital (No: 19H058).

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Informed consent was obtained from all participants prior to their participation in the study.

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Sawada, N., Mukai, S., Takehara, Y. et al. The “Watch and Wait” Method After Chemoradiotherapy for Rectal Cancer Requiring Abdominoperineal Resection. Indian J Surg Oncol 14, 765–772 (2023). https://doi.org/10.1007/s13193-023-01831-8

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