Optimal Timing for Rectal Cancer Surgery After Total Neoadjuvant Therapy: When Does Surgery Get Really Challenging?

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Total neoadjuvant therapy (TNT) is increasingly used for locally advanced rectal cancer.
• Optimal timing for surgery after TNT is not well-defined.
• Current surgical intervals vary widely, with anecdotal evidence of increased difficulty with longer delays.

Purpose of the Study:

• To determine the optimal time window for surgery after TNT to minimize postoperative complications.
• To identify if surgical difficulty increases beyond a specific interval post-TNT.

Main Methods:

• Retrospective cohort study at a single tertiary care center.
• Analysis of 212 patients with locally advanced rectal cancer who underwent surgery after TNT.
• Primary outcome: association between time from TNT completion to surgery and postoperative complication rates.

Main Results:

• 42% of patients experienced complications, with 15% having Clavien-Dindo grade ≥3.
• Surgery performed ≥24 weeks after TNT was associated with higher rates of margin positivity, reoperations, and severe complications.
• A potential optimal window for surgery appears to be around 7-12 weeks post-TNT.

Conclusions:

• Surgical timing after TNT significantly impacts perioperative outcomes.
• Delaying surgery beyond 24 weeks post-TNT is linked to increased surgical difficulty and morbidity.
• Further multicenter studies are warranted to validate these findings and establish precise timing recommendations.