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2 "Niyaz Shadmanov"
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Colorectal cancer
Margin-driven outcomes prevail over resection planes: multivisceral surgery matches total mesorectal excision in locally advanced rectal cancer
Niyaz Shadmanov, Baris Bakir, Suha Goksel, Oktar Asoglu
Ann Coloproctol. 2026;42(2):226-236.   Published online April 27, 2026
DOI: https://doi.org/10.3393/ac.2025.00920.0131
  • 302 View
  • 15 Download
AbstractAbstract PDF
Purpose
This study compared oncologic and perioperative outcomes between patients with locally advanced rectal cancer (LARC) treated with beyond total mesorectal excision (bTME) and those with pathologic stage III disease undergoing TME.
Methods
A retrospective analysis was conducted using prospectively collected data from 580 LARC patients treated with curative-intent surgery over a 23-year period. Patients were categorized as those with clinical T4b tumors who underwent bTME with multivisceral resection (MVR) and those with pathologic stage III tumors treated with TME. Demographic, surgical, pathological, and oncologic outcomes were compared.
Results
Circumferential resection margin (CRM) positivity was similar between the groups (5.3% vs. 3.6%, P=0.467). Postoperative complications occurred more often in the bTME group (28.9% vs. 16.6%, P=0.004), although major complications were comparable (P=0.812). Five-year local recurrence (10.5% vs. 9.3%, P=0.371), distant metastasis (19.7% vs. 21.4%, P=0.140), disease-free survival (64.4% vs. 66.2%, P=0.326), and overall survival (74.8% vs. 75.5%, P=0.464) demonstrated no significant differences. Within the bTME group, 32 patients (42.1%) underwent major MVR and 44 (57.9%) underwent minor MVR. CRM positivity (6.2% vs. 4.5%, P=0.999), local recurrence (12.5% vs. 9.1%, P=0.714), and distant metastasis (25.0% vs. 15.9%, P=0.388) rates were similar. Five-year disease-free survival (61.5% vs. 72.3%, P=0.454) and overall survival (68.5% vs. 74.8%, P=0.609) favored minor MVR, although the differences were not statistically significant.
Conclusion
When negative circumferential margins are achieved, margin-driven bTME resections provide long-term oncologic outcomes comparable to standard TME in high-risk rectal cancer, although they are associated with higher overall complication rates.
Colorectal cancer
Is clinical complete response as accurate as pathological complete response in patients with mid-low locally advanced rectal cancer?
Niyaz Shadmanov, Vusal Aliyev, Guglielmo Niccolò Piozzi, Barıs Bakır, Suha Goksel, Oktar Asoglu
Ann Coloproctol. 2025;41(1):57-67.   Published online February 28, 2025
DOI: https://doi.org/10.3393/ac.2024.00339.0048
  • 12,196 View
  • 338 Download
  • 6 Web of Science
  • 7 Citations
Graphical AbstractGraphical Abstract AbstractAbstract PDF
Purpose
The standard treatment for locally advanced rectal cancer involves neoadjuvant chemoradiation followed by total mesorectal excision surgery. A subset of patients achieves pathologic complete response (pCR), representing the optimal treatment outcome. This study compares the long-term oncological outcomes of patients who achieved pCR with those who attained clinical complete response (cCR) after total neoadjuvant therapy, managed using a watch-and-wait approach.
Methods
This study retrospectively evaluated patients with mid-low locally advanced rectal cancer who underwent neoadjuvant treatment from January 1, 2005, to May 1, 2023. The pCR and cCR groups were compared based on demographic, clinical, histopathological, and long-term survival outcomes.
Results
The median follow-up times were 54 months (range, 7–83 months) for the cCR group (n=73), 96 months (range, 7–215 months) for the pCR group (n=63), and 72 months (range, 4–212 months) for the pathological incomplete clinical response (pICR) group (n=627). In the cCR group, 15 patients (20.5%) experienced local regrowth, and 5 (6.8%) developed distant metastasis (DM). The pCR group had no cases of local recurrence, but 3 patients (4.8%) developed DM. Among the pICR patients, 58 (9.2%) experienced local recurrence, and 92 (14.6%) had DM. Five-year disease-free survival rates were 90.0% for cCR, 92.0% for pCR, and 69.5% for pICR (P=0.022). Five-year overall survival rates were 93.1% for cCR, 92.0% for pCR, and 78.1% for pICR. There were no significant differences in outcomes between the cCR and pCR groups (P=0.810); however, the pICR group exhibited poorer outcomes (P=0.002).
Conclusion
This study shows no significant long-term oncological differences between patients who exhibited cCR and those who experienced pCR.

Citations

Citations to this article as recorded by  
  • Total neoadjuvant therapy in rectal cancer: The FOREST protocol, a patient‐centered approach that clusters two cohorts with different outcomes
    Hector Guadalajara, Jose Luis Domínguez‐Tristancho, Raquel Fuentes Mateo, Miguel Leon‐Arellano, Raquel Sanz‐Baro, Eleonora Geraldi, Ana Isabel Hormigo‐Sanchez, Víctor Manuel Castellano Megías, Marta Pérez Cobos, Patricia Mellado Miras, Begoña Lopez‐Botet
    International Journal of Cancer.2026; 158(3): 697.     CrossRef
  • Organ preservation in rectal cancer: Clinical basis of the watch-and-wait strategy
    Rosa M. Jimenez-Rodriguez, Fátima Aguilar-del-Castillo, Felipe Quezada-Diaz, Julio García-Aguilar
    Cirugía Española (English Edition).2026; 104(1): 800248.     CrossRef
  • Preservación del órgano en cáncer de recto: fundamentos clínicos de la estrategia watch-and-wait
    Rosa M. Jimenez-Rodriguez, Fátima Aguilar-del-Castillo, Felipe Quezada-Diaz, Julio García-Aguilar
    Cirugía Española.2026; 104(1): 800248.     CrossRef
  • Pathological Complete Response in Rectal Cancer Patients: A Correlation Between Pathological and Clinical Stage and Oncological Outcome
    Ana Grigoraș, Dragoș-Viorel Scripcariu, Ionuț Huțanu, Bogdan Filip, Mihaela-Mădălina Gavrilescu, Maria-Gabriela Aniței, Gheorghe Bălan, Viorel Scripcariu
    Cancers.2026; 18(2): 223.     CrossRef
  • Clinical–Pathologic Response Discordance After Neoadjuvant Therapy in Rectal Cancer and Its Prognostic Implications
    Aysun Arslantas Erken, Selvi Tabak Dincer
    Asia-Pacific Journal of Clinical Oncology.2026;[Epub]     CrossRef
  • The Shifting and Evolving Neoadjuvant Treatments and Surgical Platforms on Oncological Outcomes and Sphincter Preservation in Distal Rectal Cancer: A 23-Year Retrospective Experience
    Niyaz Shadmanov, Vusal Aliyev, Barıs Bakır, Suha Goksel, Oktar Asoglu
    Journal of Gastrointestinal Cancer.2025;[Epub]     CrossRef
  • Clinical implications of radiologic criteria and prognostic factors for lateral lymph node metastasis in low rectal cancer
    Gyung Mo Son
    Annals of Coloproctology.2025; 41(6): 489.     CrossRef
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