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The following is a summary of “Short-term outcomes of transanal endoscopic intersphincteric resection for locally advanced rectal cancer after neoadjuvant chemoradiotherapy: a single-center retrospective cohort study” published in the March 2025 issue of the European Journal of Surgical Oncology by Abuduaini et al.

This study aimed to compare the perioperative safety and specimen quality of transanal endoscopic intersphincteric resection (taE-ISR) versus classical intersphincteric resection (cISR) in patients with locally advanced rectal cancer (LARC) who underwent neoadjuvant chemoradiotherapy (nCRT). A retrospective analysis was conducted on the clinicopathological data of 145 patients, comprising 75 who underwent taE-ISR and 70 who received cISR. Key parameters, including baseline characteristics, perioperative outcomes, and pathological specimen quality, were assessed to determine differences between the two surgical techniques. The results indicated that intraoperative blood loss was significantly lower in the taE-ISR group compared to the cISR group (50.0 [40.0–100.0] mL vs. 70.0 [50.0–100.0] mL, P = 0.034). Additionally, adjacent organ injury occurred in only 2.6% of patients in the taE-ISR group, compared to 11.4% in the cISR group (P = 0.037). 

While the overall prevalence of postoperative complications did not differ significantly between the groups (17.3% vs. 30.0%, P = 0.072), specific complications such as pelvic abscess (1.3% vs. 8.6%, P = 0.042) and rectovaginal fistula (0.0% vs. 5.7%, P = 0.036) were observed less frequently in the taE-ISR group. Importantly, the taE-ISR group demonstrated a higher rate of complete resection compared to the cISR group (98.7% vs. 91.4%, P = 0.042). Notably, no patients in the taE-ISR cohort had positive distal resection margins (DRM), whereas four patients in the cISR group presented with positive DRM (0.0% vs. 5.7%, P = 0.036). These findings suggest that taE-ISR following nCRT is associated with superior specimen quality, lower intraoperative blood loss, and a reduced incidence of specific perioperative complications compared to cISR. The results support the feasibility and safety of taE-ISR as an effective surgical option for patients with low-LARC.

Source: ejso.com/article/S0748-7983(25)00412-3/abstract