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Purpose <p>Assessment of local response to neo-adjuvant therapy for rectal cancer incorporates digital rectal exam (DRE), endoscopy and pelvic MRI. Despite this process patients are mistakenly identified with tumour persistence or recurrence resulting in overtreatment. This retrospective cohort study aimed to investigate the assessment of patients who had a complete pathological response (ypT0N0) after neo-adjuvant treatment for rectal cancer and evaluate clinical decision making.</p> Method <p>ypT0N0 cases were identified from a cohort of patients discussed at the Royal North Shore Hospital Colorectal Cancer Multidisciplinary Meeting (MDT) treated for rectal cancer from January 2016 to December 2024. The medical record was accessed to retrieve clinical information. Decision making was assessed from MDT discussion records.</p> Results <p>110 patients were treated with neo-adjuvant therapy during the study period, with 71 proceeding to surgery. Twelve patients (17%) had ypT0N0 pathology. The decision to resect was prompted by concerning tumour signal on MRI (10/11), endoscopic evidence of tumour (3/6), palpable disease on DRE (3/9) and biopsy (2/3). Discordant investigations were common. The sensitivity and specificity of MDT decisions for complete clinical response were 61% and 95% respectively. Patients underwent either abdominal perineal resection or ultralow anterior resection; (6/12) experienced Clavien-Dindo 3 or 4 complications.</p> Conclusions <p>The clinical assessment of response to neo-adjuvant therapy in patients with rectal cancer is an area that requires improvement due to overtreatment. ypT0N0 patients often have discordant investigations. Management decisions based on the concordance of investigations may reduce the number of ypT0N0 resections.</p>

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Optimising response assessment to neoadjuvant therapy in rectal cancer to reduce the incidence of ypT0N0 resection

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月29日

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  • Jonathan Hew,
  • Ali Mohtashami,
  • Katerina Mastrocostas,
  • Tracey Skinner,
  • Keshani De Silva,
  • Nick Pavlakis,
  • George Hruby,
  • Justin Evans,
  • Yasser Salama,
  • Andrew Kneebone,
  • Kah Hoong Chang

摘要

Purpose

Assessment of local response to neo-adjuvant therapy for rectal cancer incorporates digital rectal exam (DRE), endoscopy and pelvic MRI. Despite this process patients are mistakenly identified with tumour persistence or recurrence resulting in overtreatment. This retrospective cohort study aimed to investigate the assessment of patients who had a complete pathological response (ypT0N0) after neo-adjuvant treatment for rectal cancer and evaluate clinical decision making.

Method

ypT0N0 cases were identified from a cohort of patients discussed at the Royal North Shore Hospital Colorectal Cancer Multidisciplinary Meeting (MDT) treated for rectal cancer from January 2016 to December 2024. The medical record was accessed to retrieve clinical information. Decision making was assessed from MDT discussion records.

Results

110 patients were treated with neo-adjuvant therapy during the study period, with 71 proceeding to surgery. Twelve patients (17%) had ypT0N0 pathology. The decision to resect was prompted by concerning tumour signal on MRI (10/11), endoscopic evidence of tumour (3/6), palpable disease on DRE (3/9) and biopsy (2/3). Discordant investigations were common. The sensitivity and specificity of MDT decisions for complete clinical response were 61% and 95% respectively. Patients underwent either abdominal perineal resection or ultralow anterior resection; (6/12) experienced Clavien-Dindo 3 or 4 complications.

Conclusions

The clinical assessment of response to neo-adjuvant therapy in patients with rectal cancer is an area that requires improvement due to overtreatment. ypT0N0 patients often have discordant investigations. Management decisions based on the concordance of investigations may reduce the number of ypT0N0 resections.