Treatment outcomes following TME for biologically unfavorable locally advanced rectal cancer
Recommended Citation
Aleissa MA, Gharib HK, Aref AM, Zeni A, Alame A, Drelichman E, Bhullar J. Treatment outcomes following TME for biologically unfavorable locally advanced rectal cancer. Colorectal Dis 2025; 27.
Document Type
Conference Proceeding
Publication Date
8-30-2025
Publication Title
Colorectal Dis
Abstract
Aim: Many centers now offer organ preservation for locally advanced rectal cancer patients. Our group conducted Phase II trials evaluating this approach, recommending nonoperative management only for patients achieving a complete clinical response (CCR) after total neoadjuvant therapy (TNT). Total mesorectal excision (TME) was advised for non-responders (primary TME), residual cancer after limited local excision (completion TME), or recurrence/regrowth (salvage TME). This study examines outcomes in these biologically unfavorable cases. Methods: All patients received induction FOLFOX followed by chemoradiation, with restaging 12-20 weeks post-TNT. Treatment variables (FOLFOX cycles, radiation dose, consolidation chemo) were tailored to tumor response. Of 35 enrolled patients (mean age 65, 51% female), mean follow-up was 4.4 years. Pelvic control was achieved in all cases, though two developed distant metastases. Results: A total of 35 patients were enrolled between 2016 and 2022, with a mean age of 65 years (range: 40-86). Of these, 51% were female (n = 18) and 49% male (n = 17). The mean tumor distance from the anal verge was 4.6 cm, and the mean tumor length was 4.3 cm. The mean follow-up was 4.4 years. One patient had completion TME, 11 underwent primary TME, and two had salvage TME. 38% (n = 6) had an Abdominoperineal Resection (APR), and 54% (n = 8) had Low Anterior Resection (LAR), all with a diverting loop ileostomy. Surgeries were minimally invasive, with six robotic and the rest laparoscopic. Postoperative complications occurred in 35% (n = 4), with two patients requiring ICU care. Ultimate pelvic control was achieved in all, with two patients developing distant metastases (lung and liver). Conclusion: Salvage TME outcomes are satisfactory, supporting organ preservation strategies.
Volume
27
