European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Delayed total mesorectal excision after rectal-sparing strategies, oncologic safety and surgical outcomes: a propensity score-matched study from ReSARCh trial.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Bao Quoc Riccardo, Pulvirenti Alessandra, Parati Carlotta, Battisti Giulia, Delrio Paolo, Restivo Angelo, Chiloiro Giuditta, Coco Claudio, Del Bianco Paola, Gambacorta Maria Antonietta, Rega Daniela, Spolverato Gaya, ReSARCh study group
Аннотация
BACKGROUND: In rectal cancer patients managed with rectal-sparing after neoadjuvant chemoradiotherapy (nCRT), total mesorectal excision (TME) is recommended in selected cases, such as local regrowth, recurrence, or high-risk histopathological features. However, the oncologic impact of delayed TME remains unclear. This study aimed to assess whether delayed TME compromises oncologic outcomes and increases postoperative complications.
METHODS: Patients were identified from a prospective, multicentre observational study (ReSARCh trial, NCT02710812). Those who underwent TME following rectal-sparing approach-either as completion surgery (cTME) after local excision (LE), or as salvage surgery (sTME) for local regrowth after watch-and-wait (WW) strategy or local recurrence after LE-were included in the delayed TME group. This cohort was propensity score-matched 1:2 to a control group of patients who underwent standard TME after nCRT at our institution. Primary outcomes were overall survival (OS) and cumulative incidence of recurrence (overall, local, distant).
RESULTS: Overall, 38 patients were included in delayed TME and 217 in standard TME groups. Among delayed TME patients, 25 (65.8%) had prior LE and 13 (34.2%) were managed with WW. cTME was performed in 18 cases (47.4%) and sTME in 20 (52.6%). After matching, 66 patients were included in standard TME group. Thirty-day complications, reintervention and mortality were comparable. At a median follow-up of 44 months, 5-year OS was similar. The 5-year cumulative incidence of overall recurrence was 18% vs 28% (p = 0.5), and distant recurrence 15% vs 26% (p = 0.4).
CONCLUSION: Delayed TME after rectal-sparing strategies does not appear to compromise survival or increase recurrence.
METHODS: Patients were identified from a prospective, multicentre observational study (ReSARCh trial, NCT02710812). Those who underwent TME following rectal-sparing approach-either as completion surgery (cTME) after local excision (LE), or as salvage surgery (sTME) for local regrowth after watch-and-wait (WW) strategy or local recurrence after LE-were included in the delayed TME group. This cohort was propensity score-matched 1:2 to a control group of patients who underwent standard TME after nCRT at our institution. Primary outcomes were overall survival (OS) and cumulative incidence of recurrence (overall, local, distant).
RESULTS: Overall, 38 patients were included in delayed TME and 217 in standard TME groups. Among delayed TME patients, 25 (65.8%) had prior LE and 13 (34.2%) were managed with WW. cTME was performed in 18 cases (47.4%) and sTME in 20 (52.6%). After matching, 66 patients were included in standard TME group. Thirty-day complications, reintervention and mortality were comparable. At a median follow-up of 44 months, 5-year OS was similar. The 5-year cumulative incidence of overall recurrence was 18% vs 28% (p = 0.5), and distant recurrence 15% vs 26% (p = 0.4).
CONCLUSION: Delayed TME after rectal-sparing strategies does not appear to compromise survival or increase recurrence.