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February 28, 2026Annals of ColoproctologyOpen Access

Upfront surgery versus preoperative chemoradiotherapy: a comparative survival analysis for stage II/III resectable rectal cancer

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Key result

TaTME linked to a ~2% three-year local recurrence rate in mid or low rectal carcinoma.

  • n=159

Why the study?

Neoadjuvant chemoradiotherapy reduces local recurrence in locally advanced rectal cancer but does not improve survival and increases overtreatment, prompting investigation into whether upfront surgery compromises oncologic outcomes.

Population

348 patients with stage II/III locally advanced rectal cancer

Comparison

Upfront total mesorectal excision vs neoadjuvant chemoradiotherapy followed by total mesorectal excision

Design

Propensity score matching comparative study

Follow-up

5-year

Authors

NSNattapanee SukpholTLThitithep Limvorapitak

Discussion

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Member takes

Overview

Supports TaTME as safe for selected mid/low rectal cancer cases; confirms equivalent long-term outcomes to standard TME after propensity score matching.**[[1]](https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2026.1715774/full)[[2]](http://coloproctol.org/journal/view.php?doi=10.3393/ac.2022.00178.

Key Points

  • This study aims to compare the oncologic outcomes of upfront surgery and neoadjuvant chemoradiotherapy in patients with stage II/III resectable rectal cancer.
  • Analyzed using propensity score matching.
  • Compared long-term survival outcomes between upfront TME and nCRT followed by TME.
  • Evaluated primary and secondary endpoints related to survival outcomes over five years.
  • Upfront TME showed higher 5-year disease-free survival (63.3% vs. 43.9%).
  • Distant metastasis-free survival was significantly higher in the upfront TME group (88.1% vs. 70.3%).
  • No significant differences in survival outcomes after excluding patients with preoperative MRF involvement.
  • Kaplan-Meier survival analysis revealed no significant differences in any endpoints in the matched cohort.

Study Design

Type

Observational (n=159)

Multicenter

Yes

Structured PICO

P
Population
159 patients with histological proven distal or mid rectal carcinomas who had elective transanal total mesorectal excision (TaTME), mean age 66.9, 66.7% male, treated at two referral centers in The Netherlands.
I
Intervention
Transanal total mesorectal excision (TaTME)
O
Outcome
Locoregional recurrencehard clinical

Limitations

  • Observational design without randomized comparator group
  • Data from only two high volume tertiary referral centers limiting generalizability
  • Low number of local recurrence events preventing multivariate analysis
  • Learning curve and surgeon experience may influence outcomes
  • No direct comparison to other surgical techniques in this cohort

Cite This Study

Sukphol et al. (2026) conducted an observational in Patients with mid or low rectal carcinoma undergoing transanal total mesorectal excision (TaTME) with curative intent (n=159). Transanal total mesorectal excision (TaTME) was evaluated on Local recurrence rate after TaTME. Transanal total mesorectal excision (TaTME) was associated with a 3-year local recurrence rate of 2.0% and a 5-year local recurrence rate of 4.0% in patients with mid or low rectal carcinoma.

synapsesocial.com/papers/69a285da0a974eb0d3c00cd8https://doi.org/10.3393/ac.2025.00724.0103
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Ten-Year Outcomes of Patients with Rectal Cancer Remaining Lymph Node Positive After Preoperative Radiochemotherapy2026
  2. 2Upfront Total Mesorectal Excision for MRI-Defined Low-Risk cT3 Rectal Cancer: A Systematic Review and Meta-Analysis2026
  3. 3Clinical outcomes of neoadjuvant chemoradiotherapy followed by total mesorectal excision in locally advanced rectal cancer with mesorectal fascia involvement2024 · 4 citations
  4. 4Transanal endoscopic microsurgery vs. radical surgery for mid-low rectal cancer in patients with clinical complete or near-complete response after neoadjuvant chemoradiotherapy.2024
  5. 5Efficacy and safety of neoadjuvant chemoradiotherapy versus chemotherapy alone in locally advanced rectal cancer2025