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. Keywords: Local excision; Neoadjuvant chemoradiotherapy; Organ preservation; Propensity score matching; Rectal cancer; Salvage surgery; Total mesorectal excision; Watch-and-wait. Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved.
Delayed total mesorectal excision after rectal-sparing strategies, oncologic safety and surgical outcomes: a propensity score–matched study from ReSARCh trial
Pulvirenti A.;Battisti G.;Bonomo M.Membro del Collaboration Group
;Perin A.;Urso E. D. L.Membro del Collaboration Group
;Bigon M.Membro del Collaboration Group
;Pucciarelli S.Membro del Collaboration Group
;
2026
Abstract
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. Keywords: Local excision; Neoadjuvant chemoradiotherapy; Organ preservation; Propensity score matching; Rectal cancer; Salvage surgery; Total mesorectal excision; Watch-and-wait. Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved.
Pubblicazioni consigliate
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
