Organ preservation for rectal cancer
Seance of wednesday 05 march 2025 (Journée cancérologie : Cancer colorectal)
DOI number : 10.26299/48j3-zp41/2025.09.11
Abstract
There are two types of organ preservation for rectal cancer: 1) selective organ preservation, which is planned at the time of initial management and is intended for small tumours cT2-T3a,bNx less than 5 cm and 2) opportunistic organ preservation, which is considered for large tumours (cT3-T4 and/or N+) more than 5 cm that exhibit an exceptional complete or near-complete response to total neoadjuvant treatment
Selective organ preservation has been validated with good long-term oncologic results and should be systematically considered for small tumours measuring less than 5 cm.
Opportunistic organ preservation is currently not validated due to risk of local tumour regrowth round about 25-35%. This is an independent poor prognosis factor compromising both oncological and functional results for patients. It can only be considered as an alternative to rectal resction with total mesorectal excision except in patients at high risk of surgical morbidity.
Selective organ preservation has been validated with good long-term oncologic results and should be systematically considered for small tumours measuring less than 5 cm.
Opportunistic organ preservation is currently not validated due to risk of local tumour regrowth round about 25-35%. This is an independent poor prognosis factor compromising both oncological and functional results for patients. It can only be considered as an alternative to rectal resction with total mesorectal excision except in patients at high risk of surgical morbidity.