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Updated: Jan 9, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Neoadjuvant Radiochemotherapy for Locally Advanced Rectal Cancer: A Single-institutional Real-world Study
Ralph Muecke1,2, Khashayar Fakhrian3,4, Robert Gosenheimer5
1Department of Radiotherapy and Radiation Oncology, Ruhr University Bochum, Bochum, Germany; r.muecke@strahlentherapie-rheinmainnahe.de.
Background/Aim:
We aimed to assess the results of neoadjuvant radiochemotherapy (N-RCT) in a cohort of 54 patients with middle and lower third locally advanced rectal cancer (LARC) treated in real-world practice at a German certified oncologic rectal center for the treatment of rectal cancer.
Patients And Methods:
From September 2016 to December 2023, 54 patients (median age of 66.5 years, range=33-82 years) with middle and lower third rectal cancer received N-RCT. Mean tumor distance from anal verge was 5.34 cm (±2.93). The distribution into UICC stages was as follows: stage II, n=6; stage III, n=45; stage IV, n=3. All patients received conventionally fractionated radiotherapy (50.4 Gy in 1.8 Gy fractions) using the volumetric intensity modulated arc therapy (VMAT) technique and simultaneous chemotherapy with capecitabine 825 mg/m2 bid (d1-42). Total mesorectal excision (TME) was performed six to eight weeks after the N-RCT. Adjuvant chemotherapy was performed in 34/54 patients after surgery in accordance with the German S3 guideline.
Results:
With a median follow-up of 38 months (range=4-79), local recurrence occurred in 4 out of 54 patients (7%), and distant metastasis in 11 out of 54 patients (20%). During the follow-up period, 8 out of 54 patients (15%) died. The 3-year overall survival and disease-free survival rates were 91% and 76%, respectively. Pathological downstaging (ypT < cT) was achieved in 28 of 54 patients (52%) (p=0.001), and ypN ≤ cN in 35 out of 54 patients (65%) (p=0.001). Among the 54 patients who underwent surgery, 53 had an R0 resection, while 1 patient had an R1 resection. Sphincter-preserving surgery was performed in 26 patients (48%). A pathological complete response (pCR) was observed in 7 patients (13%). No grade 3 or 4 radiogenic side effects were observed.
Conclusion:
This study demonstrates that N-RCT followed by TME yields favorable oncological outcomes with manageable toxicity in patients with locally advanced rectal cancer. Our results align with previously published findings. Further research is required to optimize patient selection and to assess the long-term benefits of evolving neoadjuvant strategies in routine clinical practice.
