Orals

Aim: Organ-preserving strategies, including both "watch-and-wait" (WW) and local excision policies, represent a major advance in the management of mid and low rectal cancer.The aim of this multicenter observational study was to describe recent French practices regarding these strategies.Method: From October 2022 to March 2023, patients with mid and low rectal cancers without distant metastases and who received neoadjuvant treatment were prospectively included in 27 centers of the GRECCAR group.Endpoints were to assess neoadjuvant management and policies in organ preservation, including both comparison between selective (cT2-3 4 cm-N0-1-EMVI-) and opportunistic (cT2-3 > 4 cm, T4, cN2, EMVI+, CRM+) approaches and comparison between watch-and-wait and local excision for a 6-month period in a national level.Results: Overall, 431 patients were included, with 9% stage I, 23% stage II and 68% stage III as initial TNM stage.After neoadjuvant treatment, an organ preservation strategy was proposed in 21 centers (78%) for 92 patients (21%).Among these patients, neoadjuvant therapies were: TNT with induction chemotherapy (n = 52, 57%), chemoradiotherapy (n = 20, 22%), TNT with consolidation chemotherapy (n = 9, 10%), immunotherapy (n = 4, 4%), radiotherapy (n = 4, 4%), and chemotherapy alone (n = 3, 3%).When initial stage and tumour size were available (n = 417), a selective approach was chosen in 36 out of 83 patients (43%), and an opportunistic approach in 54 out of 334 patients (16%) (p < 0.0001).Local excisions were performed in 22% (8/36) and in 17% (9/54) of selective and opportunistic approaches, respectively (p = 0.51). Conclusion:This study showed that organ preservation is currently proposed in 1 in 5 patients with mid and low rectal cancer, with a significant preference for the selective approach including both LE and WW.Long-term results are needed to determine the impact of this strategies.