Related Experiment Video
Updated: Oct 6, 2026
Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer
Published on: February 12, 2022
A Word of Caution: Watch and Wait in the Total Mesorectal Excision Era
K Broughton1, R Cohen1,2,3,4, A Armanios1
1Department of General Surgery, Fiona Stanley Hospital, Perth, Australia.
Background:
Watch and wait strategies offer organ preservation for selected patients with rectal cancer following neoadjuvant chemoradiotherapy (nCRT). Long-term outcomes following nCRT and total mesorectal excision (TME) provide important context for evaluating these approaches. We report regional surgical, pathological, and long-term oncological outcomes following nCRT and TME, with oncological outcomes stratified by treatment response.
Methods:
A multicentre retrospective cohort study included patients with rectal cancer treated with curative-intent nCRT followed by TME across four Western Australian centres between 2006 and 2020. Overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were estimated using Kaplan-Meier methods. Local and metastatic recurrence were estimated using cumulative incidence functions, with death without the recurrence of interest treated as a competing event. Outcomes were stratified by baseline clinical stage, pathological stage, and American Joint Committee on Cancer (AJCC) tumour regression grade (TRG).
Results:
Among 573 patients, anastomotic leak occurred in 10.8% of patients with an anastomosis and an intended permanent stoma was formed in 31.9%. A pathological complete response occurred in 21.8%, and 3.1% had a positive circumferential resection margin. Five-year OS was 85.7%, CSS was 89.3% and DFS was 76.7%. The five-year cumulative incidences of local and metastatic recurrence were 3.4% and 16.5%, respectively. Baseline clinical stage was not associated with oncological outcomes, whereas pathological stage and AJCC TRG provided significant prognostic stratification. Five-year DFS was 92.2% for TRG 0% and 62.9% for TRG 3, with corresponding metastatic recurrence of 3.9% and 24.9%.
Conclusion:
Long-course nCRT followed by TME achieved favourable long-term oncological outcomes. Pathological stage and AJCC TRG provided greater prognostic stratification than baseline clinical stage. These response-stratified estimates provide regional context for evaluating contemporary organ-preservation programmes.
