e22 LETTER TO THE EDITOR choice. It provides important information on functional outcome, information we can use to counsel patients about the quality of life of the different treatment options. To the Editor—Thank you for the comments. As the We acknowledge the “far more interesting question” authors point out, our comparison carries some apple- on a different group of patients with low-risk tumors (safe orange effect, because it is not a randomized trial. Our circumferential resection margin, ≤cN1, ≤cT3a/b), who watch-and-wait patients all had the standard indication could be treated only by surgery, but who also have a higher for neoadjuvant chemoradiation. This is why we chose chance of organ preservation when treated with upfront a control group consisting of patients with neoadjuvant chemoradiation. These treatment choices for this group of chemoradiation and total mesorectal excision resection. patients are investigated in the recently started STARTREC This would have been the treatment if they had followed the randomized trial (clinicaltrials.gov: NCT02945566). standard guidelines. An additional assumption underlying the choice of our control group is that the functional Britt J.P. Hupkens, M.D. problems are mainly caused by the chemoradiation and/ Geerard L. Beets, M.D., Ph.D. or the total mesorectal excision resection, and not by the Stéphanie O. Breukink, M.D., Ph.D. degree of response. That is why we still feel this is a valid Maastricht, The Netherlands © The ASCRS 2018 Dis Colon Rectum 2018; 61: e22 DOI: 10.1097/DCR.0000000000001019 © The ASCRS 2018 Copyright © The American Society of Colon & Rectal Surgeons, Inc. Unauthorized reproduction of this article is prohibited.
Diseases of the Colon & Rectum – Wolters Kluwer Health
Published: Mar 1, 2018
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