ArticleTechniques in coloproctology2026
Tumor regression pattern and distribution of residual tumor cells in potential candidates for local excision of rectal cancer: a prospective cohort study.
Article in Techniques in coloproctology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundUnderstanding the patterns of regression and distribution of residual tumor cells (RTCs) is crucial for selecting appropriate candidates for local excision of ypT0-2 rectal cancer.
methodsPatients with extraperitoneal T3/T4 N0/N + rectal adenocarcinoma (< 10 cm) treated with radiotherapy (5 × 5 Gy) followed by six cycles of CAPOX chemotherapy were prospectively analyzed. The tumor regression pattern was classified as solid or fragmented, and microscopic intramural spread (MIS) was measured. A novel RTC distribution model was used: type I (luminal), type II (invasive front), type III (concentric), and type IV (random).
resultsA total of 40 patients were included (median age, 66 years; 57.5% male). Of these, 19 (47.5%) had ypT0-2 tumors: 5 ypT0, 3 ypT1, and 11 ypT2. There was no lymph node involvement, and only two (10.5%) showed a fragmented pattern; both ypT2. MIS was present in four cases (21.0%); all ypT2. The greatest MIS extension was 8 mm. All three ypT1 cases had RTCs in the mucosa (100%). Among 11 ypT2 cases, RTCs were found in the mucosa in 10 (90.9%) and in the submucosa in 9 (81.8%). RTC distribution was type I in 16 cases (84.2%). Magnetic resonance imaging (MRI) tumor regression grades 1-2, RTC type I distribution, absence of MIS, and pathologic complete response were significantly associated with the occurrence of ypT0-2 (p < 0.05).
conclusionsIn this study, ypT0-2 cases were characterized by a predominantly solid regression pattern, absence of MIS, and no lymph node involvement. These findings may contribute to defining resection margins and guiding the selection of surgical techniques.
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