International guidelines recommend completion total mesorectal excision (TME) after local excision of pT2 rectal cancer with clear vertical and horizontal margins, regardless of histological risk factors1,2. This recommendation is largely based on the reported 18–26% risk of lymph node metastasis (LNM) in pT2 rectal cancer3,4. However, given the morbidity rate associated with TME5, it is important to consider the surgical risks of completion surgery in relation to the risk of LNM. A recent meta-analysis showed that depth of invasion is not an independent risk factor for LNM in pT1 colorectal cancer6. In deep submucosal invasive cancer without additional histological risk factors, the risk of LNM is 3%, suggesting that completion TME can be safely omitted. Our hypothesis is that isolated muscularis propria invasion is not a strong risk factor for LNM. Therefore, this study aimed to evaluate the LNM rate in clinically node-negative (cN0) patients with pT2 rectal cancer and no additional histological risk factors.
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Albers et al. (2025) studied this question.