Skip to main content
2025 ASCRS Annual Scientific Meeting Main banner
Final Program


Visit ASCRS U
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
CME
CME
Invitation/Ticketed Event
Invitation/Ticketed Event
Invited Lectureship
Invited Lectureship
Award Recipient
Award Recipient
Self-Assessment
Self-Assessment
Social
Social
Industry
Industry
Back

Session: ePoster: Rectal Cancer 9 (Mon115)

EP825 - Pelvic exenteration should be considered in T4b rectal cancer below the peritoneal reflection

Monday, May 12, 2025
1:42 PM – 1:47 PM PT

    ePoster Presenter(s)

  • HYE-JIN KIM

    Associated professor
    Kyungpook National University Chilgok Hospital
    Daegu, Taegu-jikhalsi, Republic of Korea

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • GC

    Gyu-Seog Choi, n/a

    professor
    Kyungpook National University Chilgok Hospital
    daegu, Taegu-jikhalsi, Republic of Korea

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • JP

    Jun Seok Park, n/a

    professor
    Kyungpook National University Chilgok Hospital
    Dae Ku, Taegu-jikhalsi, Republic of Korea

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • SP

    Soo-Yeun Park, n/a

    Associate Professor
    Kyungpook National University Chilgok Hospital
    Taegu, Taegu-jikhalsi, Republic of Korea

    Disclosure information not submitted.

  • Seungho Song

    Assistant professor
    Kyungpook National University Chilgok Hospital
    Daegu, Taegu-jikhalsi, Republic of Korea

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
HYE-JIN KIM: This individual has no financial relationships with ineligible companies.
Gyu-Seog Choi, n/a: This individual has no financial relationships with ineligible companies.
Jun Seok Park, n/a: This individual has no financial relationships with ineligible companies.
Seungho Song: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Despite advances in rectal cancer surgery, T4b rectal cancer, characterized by invasion beyond the rectal wall into adjacent structures, poses a clinical challenge. This challenge arises from the imperative need for multi-visceral resection to achieve a clear resection margin. After neoadjuvant treatment, the decision to preserve the pelvic compartment based on tumor response has been left to the discretion of the surgeon. However, there is limited data available regarding oncologic outcomes corresponding to the extent of resection following neoadjuvant treatment in T4b rectal cancer. This study aimed to assess the impact of the extent of surgery by changing the surgical strategy according to tumor response in T4b rectal cancer identified in initial MRI.

Methods/Interventions: Between 2011 and 2021, patients with non-metastatic T4b rectal cancer were retrospectively evaluated. Primary outcome measures were local recurrence-free survival (LRFS) and cancer-specific survival (CSS). Surgical procedures were categorized into three groups: total mesorectal excision (TME), extended-TME (eTME) and pelvic exenteration (PE).

Results/Outcomes: A total of 108 patients with initial T4b rectal cancer were identified. All patients underwent neoadjuvant treatment. During the operation, 81 patients (75.0%) were still considered T4b, undergoing multi-visceral resection, with 60 patients (55.6%) by eTME and 20 patients (18.5%) by PE. Pathologic examination revealed 32 patients (29.6%) diagnosed as T4b, and 23 (21.2%) were diagnosed with poorly differentiated or mucinous cancer. The 5-year LRFS was 86.8%, and CSS was 82.1%. On multivariate analysis, LRFS was significantly associated with tumor invasion below peritoneal reflection (HR 8.576; 95% CI 1.077-68.296; P = 0.042), perforation with abscess formation (HR 3.4989; 95% CI 1.142-10.657; P = 0.028), and poorly differentiation (HR 6.921; 95% CI 2.163-22.137; P = 0.001). CSS was significantly associated with tumor invasion below peritoneal reflection (HR 6.982; 95% CI 1.465-33.280; P = 0.015), perforation with abscess formation (HR 2.854; 95% CI 1.092-7.462; P = 0.032), and poorly differentiation (HR 4.211; 95% CI 1.284-13.874; P = 0.018).In patients with tumor invaded the adjacent structures below the peritoneal reflection, those who underwent PE showed significantly better 5-year LRFS than those who underwent eTME (70.4% vs. 85.7%, P = 0.034).

Conclusion/Discussion: This study demonstrates that PE can provide good local control and long-term survival than eTME in patients with T4b rectal cancers below the peritoneal reflection. Although changing surgical strategy in accordance with the tumor response after neoadjuvant treatment in rectal cancer is an attractive concept from the organ preservation strategy, such decision should be carefully guided by considerations of oncologic safety.