BACKGROUND: Surgical resection, the primary treatment for locally recurrent rectal cancer (LRRC), is technically challenging. Transanal/transperineal minimally invasive surgery (Ta/Tp MIS) improves visualization and access through undisturbed planes. This study compared the short- and mid-term outcomes of Ta/Tp MIS with those of conventional non-Ta/Tp MIS for LRRC. METHODS: This retrospective observational study involved 98 patients who underwent curative-intent surgery for LRRC at a single tertiary cancer center between April 2008 and March 2022. Patients were classified into Ta/Tp MIS (n = 34) and non-Ta/Tp MIS (n = 64) groups. Perioperative and mid-term oncologic outcomes were compared, including operative time, blood loss, intraoperative transfusion, postoperative complications, pathological R0 resection, recurrence-free survival, local recurrence, and overall survival. RESULTS: Ta/Tp MIS was associated with reductions in resection time (median, 225 versus 252 min; p = 0.0176), blood loss (median, 420.5 versus 1068 mL; p < 0.0001), and intraoperative transfusions (17.7% versus 48.4%, p = 0.0041), and tended toward a shorter operative time (median, 366.5 versus 418.5 min; p = 0.1170). R0 resection (91.2% versus 89.1%), postoperative complications (overall Clavien-Dindo complication grade: 76.5% versus 75.0%, p = 1; grade ≥ 3: 41.2% versus 37.5%, p = 0.8282), 3-year recurrence-free survival (46.3% versus 44.2%, p = 0.9079), local recurrence (24.8% versus 37.7%, p = 0.3130), and 3-year overall survival (89.7% versus 77.7%, p = 0.2271) were comparable between groups. CONCLUSIONS: Ta/Tp MIS appears to be a feasible surgical approach for selected patients with LRRC, and in this retrospective analysis, was associated with shorter resection time and reduced blood loss. No clear differences were observed in postoperative complications or short- to mid-term oncologic outcomes compared with conventional approaches.
Tsukada et al. (2026) studied this question.