High nodal positivity rates even in good clinical responders after XXXX : is organ preservation feasible?

@entity5 @entity1 @entity1358 @entity66
AIM: Local excision (LE) is emerging as a treatment option for @entity5 responding well to chemoradiation. However, it does not address the mesorectal nodal burden. We aimed to identify the factors influencing nodal positivity and subsequently defined a low-risk group by including only @entity1 at low risk. METHOD: A single-centre, retrospective database analysis was carried out of @entity1 with radically resected @entity5 after neoadjuvant chemoradiation. RESULTS: This study included 524 @entity1 with @entity5 . Nodal positivity among ypT0, T1 and T2 groups was 14.7%, 28% and 30%, respectively. Multivariate analysis with stepwise logistic regression identified the following low-risk features: age >=   40  years, nonsignet @entity1358 (SRCC) histology and pathological complete response (pCR). Sixty-nine @entity1 fulfilling all three criteria were analysed and the nodal positivity was found to be 10.1%, which implies that, if these @entity1 had been selected for LE, one in 10 would have had positive mesorectal nodes. CONCLUSION: Even in @entity1 with low-risk criteria (pCR, non-SRCC histology and age >=   40  years), the residual positive @entity66 burden is 10%. Whether this high incidence of residual @entity66 translates into a similar risk of locoregional recurrence if an organ-preservation strategy is adopted is unclear.
