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June 28, 2026The American Surgeon

Upfront Total Mesorectal Excision for MRI-Defined Low-Risk cT3 Rectal Cancer: A Systematic Review and Meta-Analysis

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Authors

BPBernardo Fontel PompeuCBCamila Haddad BaptistaTAThais Henriques Abud

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Overview

Randomized trial compares upfront total mesorectal excision with neoadjuvant therapy in low-risk cT3 rectal cancer, suggesting similar outcomes.

Key Points

  • This analysis aims to compare the efficacy of upfront total mesorectal excision against neoadjuvant therapy in low-risk cT3 rectal cancer patients as determined by MRI.
  • Systematic search of PubMed, Scopus, and Cochrane Central through June 2025.
  • Five studies including 1447 patients were analyzed using random-effects models to calculate pooled odds ratios, mean differences, and hazard ratios.
  • A Bayesian random-effects meta-analysis provided insights into potential equivalence between both treatment strategies.
  • Upfront surgery resulted in shorter operative time (mean difference −25.7 min; 95% CI −38.6 to −12.7).
  • More lymph nodes were retrieved during upfront surgery (mean difference 6.6; 95% CI 6.0-7.3).
  • No significant differences were found in perioperative complications, including anastomotic leaks or reoperations.

Cite This Study

Pompeu et al. (2026) studied this question.

synapsesocial.com/papers/6a40bae361bb0a67205c6a0dhttps://doi.org/10.1177/00031348261465395
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Also Consider

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

  1. 1Long-term outcomes of upfront surgery for magnetic resonance imaging-defined T3 rectal cancer with uninvolved circumferential resection margin2026
  2. 2Upfront surgery versus preoperative chemoradiotherapy: a comparative survival analysis for stage II/III resectable rectal cancer2026
  3. 3Robotic, transanal, and laparoscopic total mesorectal excision for locally advanced mid/low rectal cancer: European multicentre, propensity score-matched study2024 · 30 citations
  4. 4Statewide Analysis of Outcomes in Patients with Early-Stage Rectal Cancer Undergoing Standard-of-Care Upfront Resection2026
  5. 5Neoadjuvant Chemotherapy Versus Upfront Surgery for <scp>cT2N1</scp> or <scp>cT3a</scp> ‐ <scp>bN0</scp> ‐1 Middle‐High Rectal Cancer2026