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Updated: Jun 25, 2025

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
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Pathologic Outcomes of Short-Course and Long-Course Radiotherapy for Locally Advanced Rectal Cancers Treated With

Brian Williams1, Abhinav Gupta1, Priyanka Iype2

  • 1Division of Colorectal Surgery, Keck Hospital of USC, Los Angeles, CA, USA.

The American Surgeon
|May 21, 2024
PubMed
Summary
This summary is machine-generated.

Total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC) using short-course radiotherapy (SCRT) or long-course radiotherapy (LCRT) showed similar pathologic outcomes. Further trials are needed to confirm long-term clinical benefits of SCRT versus LCRT in LARC patients.

Keywords:
colorectallocally advanced rectal cancerradiotherapysurgical oncologytotal neoadjuvant therapy

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Area of Science:

  • Colorectal Surgery
  • Oncologic Surgery
  • Rectal Cancer Treatment

Background:

  • Total neoadjuvant therapy (TNT) is the standard of care for locally advanced rectal cancer (LARC).
  • Randomized trials indicate short-course radiotherapy (SCRT) and long-course radiotherapy (LCRT) are oncologically equivalent for LARC.

Purpose of the Study:

  • To compare pathologic outcomes in LARC patients undergoing surgical resection after TNT.
  • To evaluate differences in outcomes between SCRT and LCRT within TNT protocols for LARC.

Main Methods:

  • Retrospective analysis of 53 LARC patients treated with TNT and proctectomy at a single tertiary hospital.
  • Patients receiving SCRT were compared with those receiving LCRT regarding lymph node yield and downstaging.

Main Results:

  • No significant differences in average lymph node yield (20.9 for SCRT vs. 17.0 for LCRT, P=.075).
  • Similar rates of achieving pN0 disease after TNT for patients with initially positive nodes (76.9% for SCRT vs. 72.2% for LCRT).
  • Pathologic complete response rates were comparable between SCRT (7.1%) and LCRT (12.8%) groups (P=.565).

Conclusions:

  • Pathologic outcomes following SCRT or LCRT as part of TNT for LARC appear similar.
  • Further prospective studies are warranted to assess long-term clinical outcomes and optimize TNT protocols for LARC.