Chemotherapy followed by local excision may be effective in patients with node-negative low rectal adenocarcinoma, according to new findings presented by Buettner et al at the 2025 Society of Surgical Oncology (SSO) Annual Meeting.
Background
The current standard of care among most patients with low rectal tumors is total mesorectal excision, which involves the removal of the affected rectum, surrounding fat, and lymph nodes. The procedure is intensive and often requires patients to have an ostomy bag afterward. Only patients with early-stage T1 rectal cancer are eligible for local excision, a less extensive surgery with more minimal side effects.
“[A]ll patients would like to avoid, if possible, having a permanent colostomy. So when they’re facing that surgical possibility, they really want to see if there’s anything else that we can do,” suggested co–study author Hannah Buettner, MD, a complex general surgical oncology fellow at Fox Chase Cancer Center.
Study Methods and Results
In the study, researchers assigned 19 patients with clinical stage T1 to T3 low rectal adenocarcinoma whose imaging showed no evidence of cancer in their lymph nodes to receive six cycles of chemotherapy. The 16 patients whose tumors shrank or disappeared following chemotherapy underwent local excision. The researchers noted that 15 of these patients met the study’s primary endpoint of negative margins.
Conclusions
“Our results found that by pairing it with chemotherapy, local excision can be an appropriate level of surgery in more cases. There are a lot of benefits. It’s a lower-risk procedure than total mesorectal excision, it has fewer side effects, and the recovery is shorter,” Dr. Buettner highlighted. “The patient might be able to go home the same day as the procedure, as opposed to spending several days in the hospital with longer recovery,” she continued.
The researchers plan to scale up the study and create a second arm for comparison.
“Our study asked [if we] can … get patients to negative margins using neoadjuvant chemotherapy. The answer, so far, is yes. Studying more patients and also having a comparison between patients who get total mesorectal excision vs local excision will be the next step in getting more robust data to help [physicians] and patients make informed treatment decisions,” Dr. Buettner concluded.
