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Updated: Jul 12, 2026
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Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Local excision for ypT2 rectal cancer--much ado about something
Rodrigo O Perez1, Angelita Habr-Gama, Igor Proscurshim
1Department of Gastroenterology, University of São Paulo School of Medicine, Rua Manuel da Nóbrega, 1564, São Paulo, SP, 04001-005, Brazil. rodrigo.operez@gmail.com
Summary
Neoadjuvant chemoradiation therapy (CRT) for rectal cancer may allow local excision for ypT2 tumors. However, 19% of ypT2 patients had lymph node metastases, indicating radical surgery is preferred.
Area of Science:
- Colorectal Surgery
- Oncology
- Gastroenterology
Background:
- Local excision for pT2 distal rectal cancer is debated due to high rates of lymph node metastases and local failure.
- Neoadjuvant chemoradiation therapy (CRT) improves local control and tumor downstaging, potentially reducing lymph node metastasis rates.
- This has led to consideration of local excision for ypT2 rectal cancer post-CRT.
Purpose of the Study:
- To evaluate the risk of unfavorable pathological features in ypT2 rectal cancer patients after neoadjuvant CRT.
- To determine if local excision is a safe option for ypT2 rectal cancer post-neoadjuvant CRT.
Main Methods:
- 401 patients with distal rectal cancer received neoadjuvant CRT.
- Patients with complete clinical response (n=112) were excluded; 289 with incomplete response underwent radical surgery.
- Patients with final pathological stage ypT2 (n=88) were analyzed for unfavorable features predicting local failure risk.
Main Results:
- Eighty-eight (30%) patients had ypT2 rectal cancer, with no association between ypT status and pretreatment radiological staging.
- ypT status significantly correlated with lymph node metastases, perineural invasion, vascular invasion, and recurrence (p=0.001).
- Lymph node metastases were found in 19% of ypT2 patients, associated with perineural invasion (47%), vascular invasion (59%), and shorter CRT-surgery interval (12 weeks). 63% had unfavorable features for local excision.
Conclusions:
- Lymph node metastases in 19% of ypT2 patients significantly correlated with poorer survival outcomes.
- Radiological staging and tumor size did not predict lymph node metastasis risk.
- Radical surgery remains the standard treatment for ypT2 rectal cancer following neoadjuvant CRT.
