Researchers studied 53 patients who had a special type of surgery to remove rectal cancer after receiving radiation and chemotherapy first. The surgery involves removing just the cancer and a small area around it, rather than removing the entire rectum. While about half the patients had some complications after surgery—mostly wound healing problems—most of these issues got better with treatment. The good news is that patients had good survival rates, with about 87% alive five years later. This study shows that this smaller surgery option can work well for certain rectal cancer patients when done carefully.

The Quick Take

  • What they studied: Whether a smaller surgical approach to remove rectal cancer (after radiation and chemotherapy) is safe and effective, and what problems patients might experience afterward.
  • Who participated: 53 patients (36 men and 17 women) with an average age of 62 years who had rectal cancer located close to the anus and received radiation/chemotherapy before surgery at a major hospital in Beijing between 2010 and 2024.
  • Key finding: About 45% of patients had complications after surgery, mostly related to wound healing, but 97% of these were minor problems that improved with treatment. The five-year survival rate was 87%, suggesting the approach works well for appropriate patients.
  • What it means for you: If you have rectal cancer near the anus, this smaller surgery option after radiation/chemotherapy may be possible and could preserve normal bowel function. However, you should be prepared for potential wound healing issues and discuss all options with your cancer doctor.

The Research Details

This was a descriptive case series study, which means researchers looked back at medical records of 53 patients who had already received this type of surgery. They collected information about what surgical techniques were used, what the pathology results showed, what complications occurred, how bowel function changed, and whether cancer came back or spread. The patients were treated at Peking Union Medical College Hospital over a 14-year period from 2010 to 2024.

The surgery involved three different techniques: transanal endoscopic microsurgery (TEM) in 47 patients, which uses a special microscope and instruments inserted through the anus; transanal minimally invasive surgery (TAMIS) in 3 patients, which is a newer minimally invasive approach; and traditional transanal local resection in 3 patients. All patients had received chemotherapy and radiation therapy before surgery to shrink their tumors.

Researchers followed patients for a median of 5 years after surgery, tracking whether cancer returned locally, spread to distant sites, or if patients survived.

This research approach is important because it provides real-world information about what actually happens to patients after this type of surgery. Rather than just looking at survival numbers, the study carefully documents all the complications that occur and how they were managed. This helps doctors and patients understand what to expect and how to handle problems if they arise. The long follow-up period (median 5 years) allows researchers to see both short-term complications and long-term cancer outcomes.

This study has some strengths and limitations. The strength is that it comes from a major medical center with experienced surgeons and includes detailed information about complications and how they were treated. The main limitation is that it’s a single-center study looking back at past cases rather than a prospective study following patients forward. There’s no comparison group of patients who had different types of surgery, so we can’t directly compare outcomes. The sample size of 53 is relatively small, which means results may not apply to all patients.

What the Results Show

About 55% of patients (29 out of 53) had a complete response to the radiation and chemotherapy, meaning no cancer cells were found in the surgical specimen. The remaining 45% had varying amounts of remaining cancer cells, with most being early-stage disease.

Complication rates were higher than typical surgery, with 45% of patients (24 out of 53) experiencing at least one complication. The most common problem was wound dehiscence (the surgical wound opening up), which occurred in 26% of patients. However, the good news is that 97% of complications were minor (Clavien-Dindo grades I-II), meaning they didn’t require major interventions. Only one patient had a serious complication—a fistula (abnormal connection) between the rectum and vagina—which required a temporary colostomy but eventually healed.

Other complications included low anterior resection syndrome (bowel dysfunction) in 13% of patients, fever in 13%, urinary retention in 6%, and diarrhea in 2%. Most of these improved with conservative treatment like antibiotics, pain medication, sitz baths, and bowel retraining exercises.

For cancer outcomes, local recurrence (cancer coming back in the same area) occurred in 8% of patients, and distant metastasis (cancer spreading to other parts of the body) occurred in 23%. Seven patients (13%) died during the follow-up period. The five-year disease-free survival rate was 76%, and the five-year overall survival rate was 87%.

Bowel function recovery was notable in patients who developed low anterior resection syndrome. Seven patients with this condition received pelvic floor exercises and bowel retraining, and all recovered normal bowel function within one year. The patient with the rectovaginal fistula underwent a temporary colostomy (surgical opening in the abdomen for bowel movements), and after six months the fistula healed, allowing the colostomy to be reversed. Among the 14 patients with wound dehiscence, seven only experienced pain and healed with pain medication alone, five had pain with bleeding that improved with conservative care, and two developed infections that required antibiotics and drainage but healed within two months.

This study aligns with existing research showing that local excision after neoadjuvant therapy (radiation and chemotherapy before surgery) is a viable option for selected rectal cancer patients. The complication rates are higher than traditional surgery but comparable to other studies of this technique. The survival rates (87% five-year overall survival) are consistent with other published series of local excision for rectal cancer. The finding that most complications are manageable with conservative treatment supports the growing use of this approach in specialized centers.

This study has several important limitations. First, it’s a single-center study from one hospital in China, so results may not apply to all populations or healthcare settings. Second, it’s a retrospective study looking back at past cases, which means some information may be incomplete or subject to bias. Third, there’s no comparison group—we don’t know how these results compare to patients who had traditional surgery removing the entire rectum. Fourth, the sample size of 53 is relatively small, so rare complications might not have been captured. Fifth, patient selection bias may exist since only certain patients were chosen for this approach. Finally, the study doesn’t include detailed quality-of-life measures beyond bowel function, so we don’t know about other aspects of recovery.

The Bottom Line

For patients with rectal cancer located close to the anus (within 8 cm) who have received radiation and chemotherapy: Local excision surgery may be a reasonable option that preserves normal bowel function and has acceptable survival outcomes (moderate confidence). Patients should expect a higher risk of wound complications but understand that most are manageable with conservative treatment (moderate confidence). Pelvic floor exercises and bowel retraining should be offered to patients who develop bowel dysfunction (moderate confidence). This approach should only be performed at experienced centers with surgeons trained in these specialized techniques (high confidence).

This research is most relevant for: patients with rectal cancer located close to the anus who want to avoid permanent colostomy; surgeons specializing in colorectal cancer who are considering this approach; and cancer centers evaluating their surgical options. This is NOT appropriate for patients with multiple cancers, those with bowel obstruction or perforation, or those with emergency bleeding. Patients should discuss whether they’re candidates with their oncology and surgical teams.

Wound complications typically appear within the first few weeks after surgery. Most minor complications resolve within 2-8 weeks with treatment. Bowel function recovery takes longer, with full normalization of bowel habits occurring over 6-12 months. Cancer recurrence can occur at any time but is most common in the first 2-3 years. The five-year follow-up period is standard for assessing long-term cancer outcomes.

Want to Apply This Research?

  • Track daily bowel function including number of bowel movements, urgency episodes, and any bleeding or pain on a 0-10 scale. Also monitor wound healing progress with photos if appropriate and note any signs of infection (fever, increased drainage, redness).
  • Users can use the app to schedule and log pelvic floor exercises (anal lifting exercises) and defecation reflex training as recommended by their healthcare provider. Set reminders for sitz baths, medication timing, and follow-up appointments. Log dietary changes and their effects on bowel function.
  • Establish a baseline of bowel function in the first month post-surgery, then track changes weekly for the first three months, then monthly for the first year. Create alerts for concerning symptoms like fever, excessive bleeding, or signs of infection that warrant contacting the healthcare provider. Monitor long-term trends in bowel function recovery and quality of life metrics.

This research describes outcomes from a specific group of 53 patients treated at one hospital in China. Individual results vary significantly based on tumor characteristics, patient health, surgeon experience, and other factors. This information is for educational purposes and should not replace discussions with your oncology and surgical teams about your specific situation. Treatment decisions should be made in consultation with qualified healthcare providers who understand your complete medical history. If you have rectal cancer, discuss all treatment options including traditional surgery, radiation, chemotherapy, and local excision approaches with your medical team to determine what’s best for you.