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Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
Navigating Shared Decision-Making in Non-Operative Management of Locally Advanced Rectal Cancer
Racquel S Gaetani1, Jonathan S Abelson1
1Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, United States.
Clinics in Colon and Rectal Surgery
|August 5, 2026
Summary
Total neoadjuvant therapy improves outcomes for locally advanced rectal cancer, offering organ preservation via watch-and-wait strategies. This approach balances functional benefits against oncologic risks, guiding personalized patient care.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Locally advanced rectal cancer management has advanced with total neoadjuvant therapy (TNT).
- TNT increases clinical complete response rates, enabling non-operative management (watch-and-wait).
- Total mesorectale excision (TME) is standard but causes significant morbidity and functional deficits.
Purpose of the Study:
- To review the comparative benefits and limitations of TME versus non-operative management.
- To highlight impacts on quality of life, recurrence risk, and patient-centered care.
- To explore strategies supporting shared decision-making in rectal cancer treatment.
Main Methods:
- Literature review of studies comparing TME and non-operative management for rectal cancer.
- Analysis of outcomes including functional results, quality of life, and oncologic control.
- Examination of decision aids and predictive modeling for patient stratification.
Main Results:
- Non-operative management offers organ preservation and improved function but carries oncologic uncertainty.
- TME provides a standard curative approach but is linked to substantial long-term functional impairment.
- Emerging tools aim to facilitate informed, individualized treatment decisions.
Conclusions:
- Shared decision-making is crucial for navigating TME and non-operative management choices.
- Evidence-based tools are needed to support personalized, ethically grounded rectal cancer care.
- The evolving landscape requires careful consideration of patient preferences and oncologic outcomes.
