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Updated: Jun 20, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Risk factors for local recurrence in patients with clinical stage II/III low rectal cancer: A multicenter
Takumi Kozu1, Takashi Akiyoshi1,2, Takashi Sakamoto1
1Gastroenterological Center, Department of Colorectal Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan.
Background:
Identifying risk factors for local recurrence (LR) is pivotal in optimizing rectal cancer treatment. Total mesorectal excision (TME) and lateral lymph node dissection (LLND) are the standard treatment for advanced low rectal cancer in Japan. However, large-scale studies to evaluate risk factors for LR are limited.
Methods:
Data from 1479 patients with clinical stage II/III low rectal cancer below the peritoneal reflection, surgically treated between January 2010 and December 2011 across 69 hospitals, were analyzed. Fine-Gray multivariable regression modeling was used to identify risk factors associated with LR. Two models were developed: one using preoperative factors only, and the other incorporating operative and postoperative factors.
Results:
Across the entire cohort, the 5-year cumulative incidence of LR was 12.3% (95% confidence interval, 10.7-14.1). The multivariable analysis associated LR with various preoperative (body mass index, distance from anal verge, cN category, and histological subtype), treatment-related (neoadjuvant therapy, and LLND), and postoperative (pT, pN, and resection margins) risk factors. For patients without neoadjuvant treatment, LR risk was unacceptably high with two or three preoperative risk factors (body mass index ≥25 kg/m2, distance from anal verge ≤4.0 cm, non-well/moderately differentiated adenocarcinoma). The 5-year cumulative incidence of LR was 24.7% in patients treated without LLND and 22.9% in patients treated with LLND.
Conclusion:
This large multicenter cohort study identified some risk factors for LR in the setting where upfront TME was predominant, offering insights to optimize rectal cancer treatment.
