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[A Case of Robot-Assisted Surgery after TNT for Advanced Rectal Cancer with Prostate Invasion]
Keita Hoshino1, Yusuke Mori, Takumi Watanabe
1Dept. of Gastrointestinal Tract Surgery, School of Medicine Fukushima Medical University.
Gan to Kagaku Ryoho. Cancer & Chemotherapy
|January 17, 2026
Summary
This study reports a rectal cancer case where neoadjuvant therapy led to tumor shrinkage, but prostate invasion persisted. Surgical removal achieved a complete response, showing no residual cancer in the prostate or lymph nodes.
Area of Science:
- Oncology
- Surgical Oncology
- Radiotherapy
Background:
- Rectal cancer with suspected prostate invasion presents a complex treatment challenge.
- Total neoadjuvant therapy (TNT) aims to improve outcomes for advanced rectal cancer.
- Accurate staging after neoadjuvant treatment is crucial for surgical planning.
Purpose of the Study:
- To describe a case of advanced lower rectal cancer treated with TNT.
- To evaluate the efficacy of TNT and subsequent surgical intervention.
- To highlight the role of robot-assisted surgery in managing complex rectal cancer cases.
Main Methods:
- A patient with lower rectal cancer underwent 7 cycles of CAPOX chemotherapy followed by short-course radiotherapy (5 Gy×5).
- Positron Emission Tomography-Magnetic Resonance Imaging (PET-MRI) was used for post-treatment assessment.
- Robot-assisted abdominoperineal resection with en bloc prostatectomy and lymph node dissection was performed.
Main Results:
- Preoperative imaging indicated persistent prostate invasion and advanced nodal disease (ycT4bN3M0, ycStage IIIc) despite tumor shrinkage.
- Pathological examination post-surgery revealed ypT3N0M0, ypStage IIa, with no residual tumor in the prostate or lymph nodes.
- The patient experienced a favorable postoperative recovery and was discharged on the 17th postoperative day.
Conclusions:
- Total neoadjuvant therapy can induce significant tumor response in advanced rectal cancer.
- Robot-assisted surgery enables radical resection in complex cases with favorable outcomes.
- Pathological downstaging after TNT and surgery can lead to improved staging and potentially better prognosis.
