Delayed Total Mesorectal Excision After Rectal-Sparing Strategies, Oncologic Safety and Surgical Outcomes: a Propensity Score-Matched Study from ReSARCh trial
Menée à partir de données portant sur 255 patients atteints d'un cancer du rectum (durée médiane de suivi : 44 mois), cette étude analyse l'efficacité, du point de vue de la survie globale et du taux de récidive, d'une exérèse totale du mésorectum différée
Background: In rectal cancer patients managed with rectal-sparing after neoadjuvant chemoradiotherapy (nCRT), total mesorectal excision (TME) is recommended in selected cases, such as local regrowth, recurrence, or high-risk histopathological features. However, the oncologic impact of delayed TME remains unclear. This study aimed to assess whether delayed TME compromises oncologic outcomes and increases postoperative complications.
Methods: Patients were identified from a prospective, multicentre observational study (ReSARCh trial, NCT02710812). Those who underwent TME following rectal-sparing approach—either as completion surgery (cTME) after local excision (LE), or as salvage surgery (sTME) for local regrowth after watch-and-wait (WW) strategy or local recurrence after LE—were included in the delayed TME group. This cohort was propensity score–matched 1:2 to a control group of patients who underwent standard TME after nCRT at our institution. Primary outcomes were overall survival (OS) and cumulative incidence of recurrence (overall, local, distant).
Results: Overall, 38 patients were included in delayed TME and 217 in standard TME groups. Among delayed TME patients, 25 (65.8%) had prior LE and 13 (34.2%) were managed with WW. cTME was performed in 18 cases (47.4%) and sTME in 20 (52.6%). After matching, 66 patients were included in standard TME group. Thirty-day complications, reintervention and mortality were comparable. At a median follow-up of 44 months, 5-year OS was similar. The 5-year cumulative incidence of overall recurrence was 18% vs 28% (p=0.5), and distant recurrence 15% vs 26% (p=0.4).
Conclusion: Delayed TME after rectal-sparing strategies does not appear to compromise survival or increase recurrence.
European Journal of Surgical Oncology , résumé, 2026