PURPOSE:Appendiceal mucinous neoplasms are rare tumors with heterogeneous pathology, typically treated with appendectomy, cecectomy, right hemicolectomy, or cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Survival outcomes across surgical approaches remain unclear. We evaluated the outcomes of all surgical interventions for appendiceal mucinous neoplasms. METHODS:Eligible randomized controlled trials and cohort studies were retrieved from Cochrane, PubMed, Embase, and Scopus to August, 2026. Outcomes included overall and disease-free survival, recurrence, lymph-node positivity, and postoperative complications. Random-effects models were used to pool estimates. Certainty was appraised with GRADE. RESULTS:The review included 43 observational cohort studies involving 12,014 patients. In localized appendiceal mucinous neoplasms, recurrence was 1.4% after appendectomy and 2.3% after right hemicolectomy. In pseudomyxoma peritonei with CRS + HIPEC, 30- and 90-day mortality was 1.8% and 1.8%. Five-year overall survival was 94.2%, 78.1%, and 47.4% for acellular mucin, low-grade, and high-grade cohorts; 5-year disease-free survival was 92.8%, 56.9%, and 30%. High-grade disease was associated with worse overall survival (hazard ratio (HR), 3.19; 95% confidence interval (CI), 1.88-5.41) and disease-free survival (HR, 3.06; 95% CI, 1.68-5.58). Incomplete cytoreduction was associated with worse overall survival (HR, 3.39; 95% CI, 1.54-7.45). CONCLUSIONS:In localized appendiceal mucinous neoplasms, recurrence after resection is low; nodal involvement is uncommon in low-grade lesions but more frequently observed in mucinous adenocarcinoma. In pseudomyxoma peritonei, long-term survival after CRS + HIPEC varies by histologic grade and cytoreductive completeness. These factors may inform counseling, operative planning, and surveillance, but findings require cautious interpretation given low or very low certainty.
BACKGROUND:Management of low locally advanced rectal cancer (LARC) requires balancing oncologic radicality, sphincter preservation, postoperative function, and long-term stoma acceptability. These challenges are amplified in settings where socioeconomic and cultural factors influence treatment decisions. This study aimed to provide a descriptive comparison of surgical and reconstructive pathways for LARC in France and Morocco. METHODS:This retrospective bicentric study included patients operated on between January 2017 and December 2024 for low LARC (cT3/T4 and/or node-positive adenocarcinoma within 5 cm of the anal verge). Outcomes were compared between Tours University Hospital, France (LARC-Fr), and the National Institute of Oncology, Rabat, Morocco (LARC-Mo). RESULTS:A total of 224 patients were included (80 LARC-Fr; 144 LARC-Mo). French patients were older (68 vs 57 years, p < 0.001) and had higher ASA III-IV scores (26.3% vs 2.1%, p < 0.001), whereas cT4 tumors were more frequent in Morocco (22.9% vs 7.5%, p = 0.003). Sphincter-preserving procedures, including intersphincteric resection (35.0% vs 0%, p < 0.001) and TaTME (35.0% vs 2.8%, p < 0.001), were more common in France, while abdominoperineal resection (APR) predominated in Morocco (79.2% vs 48.8%, p < 0.001). Among Moroccan patients with a definitive stoma, pseudocontinent perineal colostomy (PCPC) was performed in 64.1%. Major postoperative morbidity and reoperation rates did not differ significantly between cohorts. Complete mesorectal excision and R1 resection rates did not differ significantly. Three-year disease-free survival was 74.5% versus 73.2% (p = 0.075), and overall survival was 85.0% versus 71.9% (p = 0.279), respectively. CONCLUSIONS:This bicentric retrospective study describes distinct surgical and reconstructive pathways for low rectal cancer in France and Morocco. In the Moroccan cohort, PCPC was used after abdominoperineal resection as an alternative to a conventional permanent abdominal colostomy when sphincter preservation was not considered appropriate.
BACKGROUND:Para-aortic lymph node (PALN) metastasis in pancreatic ductal adenocarcinoma (PDAC) is generally considered unresectable. However, resection for PDAC with PALN metastasis diagnosed by intraoperative sampling remains controversial. This study aimed to develop a risk scoring system for intraoperative decision-making regarding PDAC resection. METHODS:Between 2005 and 2021, 60 patients with PALN metastasis diagnosed by intraoperative sampling were analyzed. Six pathological factors were evaluated in sampled PALNs: maximum lesion size, number of lesions, lesion localization, histological grade, desmoplastic reaction, and extranodal extension. Weighted scores were assigned using β coefficients derived from the Cox proportional hazards regression model. RESULTS:Histological grade G3 scored 3 points; maximum lesion size >2.0 mm, ≥3 lesions, and intranodal localization scored 2 points; desmoplastic reaction and extranodal extension scored 1 point. A cut-off score of 4 by 2-year time-dependent receiver operating characteristic curve analysis stratified patients into high- and low-risk groups. Patients were categorized into low-risk/resection (n = 20), low-risk/no-resection (n = 4), high-risk/resection (n = 22), and high-risk/no-resection (n = 14). Overall survival was significantly better in the low-risk/resection group than in the low-risk/no-resection group (p = 0.003), whereas there was no significant difference between the high-risk/resection and high-risk/no-resection groups (p = 0.603). Multivariable analysis identified pathological findings in the sampled PALNs (Hazard ratio = 2.463, p = 0.021) as an independent prognostic factor in 42 patients who underwent resection. CONCLUSION:The weighted risk scoring system may enable objective intraoperative decision-making and treatment optimization.
BACKGROUND:Resectability in perihilar cholangiocarcinoma (PHCC) is multidimensional, and anatomically advanced disease often necessitates highly complex surgery. Long-term outcomes of anatomically defined borderline resectable (BR) PHCC treated with preoperative chemotherapy remain unclear. METHODS:This single-center retrospective cohort study included consecutive patients with PHCC treated between May 2018 and October 2024. Patients with distant metastases were excluded. Among 142 registered patients, 42 were classified as anatomically defined BR according to institutional criteria. BR comprised Bismuth type IV disease requiring trisectionectomy, major vascular invasion requiring arterial and/or portal reconstruction, and distal extension requiring hepatopancreatoduodenectomy (HPD). All patients received gemcitabine-based preoperative chemotherapy followed by reassessment of resectability. The primary endpoint was overall survival (OS) among patients with anatomically defined BR PHCC who received preoperative chemotherapy. RESULTS:Of 42 patients with BR PHCC, 34 (81.0%) underwent resection, achieving an R0 rate of 73.5%. Resection rates varied by anatomical subtype and were lowest in Bismuth type IV disease (61.9%). Major postoperative complications (Clavien-Dindo ≥3a) occurred in 44.1%, and 90-day mortality was 2.9%. The resected group achieved a 5-year OS rate of 42.9% and a median survival of 36.6 months, compared with 19.4 months in the not-resected group (P = 0.038). For the entire BR cohort, the 5-year OS rate was 38.8%. CONCLUSIONS:In anatomically defined BR PHCC, multidisciplinary treatment with preoperative chemotherapy was associated with favorable clinical outcomes. However, resectability differed across anatomical subtypes, highlighting heterogeneity within anatomically advanced disease. Given the absence of a control group, these findings should be considered descriptive and hypothesis-generating.
BACKGROUND:For patients with early gastric cancer (EGC) who exceed the absolute indications for endoscopic submucosal dissection (ESD) or have undergone non-curative ESD, sentinel node navigation surgery (SNNS) represents a promising individualized surgical approach. This study aimed to conduct a systematic review and meta-analysis to evaluate the feasibility and diagnostic value of indocyanine green (ICG) guided SNNS in patients with EGC. METHODS:Eligible studies were systematically searched in PubMed, Web of Science, Ovid MEDLINE, Scopus and Cochrane Library from inception to March 2026. Identification rates and patient-level sensitivity were pooled separately with random-effects Freeman-Tukey double-arcsine models in StataNow/MP 19.5. Diagnostic analyses were restricted to studies with an adequate reference standard and reconstructable 2×2 data. Cohort overlap was handled with a conservative primary set and prespecified replacement analyses. Evidence after non-curative ESD was synthesized narratively. RESULTS:Nine non-overlapping cohorts were included in the primary identification analysis, yielding a identification rate of 98.8% (95% CI: 97.6-99.5%). The random-effects pooled identification rate was 99.9% (95% CI = 98.7-100.0%; I2 = 32.0%). Eight studies contributed valid patient-level diagnostic data (84 true positives, 4 false negatives, 0 false positives, and 577 true negatives), and the pooled sensitivity was 98.5% (95% CI 86.6-100.0%; I2 = 47.6%). Specificity was 100.0% (577/577), but estimation was structurally constrained because all studies reported zero false positives. Subgroup associations were exploratory. Evidence after non-curative ESD was heterogeneous and was not pooled. CONCLUSION:ICG-guided sentinel node navigation surgery shows high technical identification and promising patient-level sensitivity in selected EGC cohorts. These findings do not establish oncological non-inferiority of limited surgery. False-negative consequences, zero-cell constraints, overlap, heterogeneous pathology, and concentration of evidence in high-volume Asian centres require cautious interpretation and prospective validation.
Resection of Enneking type III pelvic tumors and the subsequent reconstruction of the anterior pelvic ring pose significant challenges due to their deep anatomical location, limited bone stock, and close proximity to vital viscera and neurovascular bundles. The optimal surgical approach for these defects remains controversial. While non-reconstruction is widely practiced to minimize operative time and infection risks, it can disrupt the load-bridging function of the anterior ring, frequently leading to long-term biomechanical instability, compensatory stress fractures, and pelvic visceral herniation. Osseous reconstruction and three-dimensional (3D)-printed implants have markedly transformed type III pelvic reconstruction by offering precise anatomical matching, porous trabecular networks for biological integration, and restored structural continuity. Many orthopedic oncology centers have adopted osseous and prosthetic reconstruction strategies, leading to reduced visceral herniation and enhanced long-term biomechanical stability. However, most studies are limited to single centers with a small number of cases and short follow-up periods. Furthermore, current surgical decision-making relies heavily on subjective functional scores and personal experience, which provokes biomechanical controversies and highlights the urgent need for standardized, evidence-based guidelines. To provide a comprehensive assessment of this clinical domain, we conducted an analysis of existing literature, encompassing anatomical and biomechanical characteristics, the evolution of reconstruction strategies, and future precision reconstruction technologies.
BACKGROUND:Local recurrence after surgical resection of bone tumors remains a major challenge. Liquid nitrogen (LN) cryotherapy is a widely used adjuvant but carries risks of spillage, fracture, and soft tissue injury. Freezing Nitrogen Ethanol Composite (FNEC), a semisolid mixture of LN and ethanol, has been proposed as a safer alternative with comparable tumoricidal effect. This scoping review aimed to synthesize experimental and clinical evidence on the efficacy and safety of FNEC in bone tumor surgery. METHODS:A scoping review was conducted per PRISMA-ScR guidelines, searching MEDLINE (via PubMed), Cochrane, Google Scholar, Semantic Scholar, Dimensions, Aminer, and OpenAlex through May 2026. Experimental (ex vivo, in vivo) and clinical studies (cohorts, case series, case reports) evaluating FNEC in bone tumors were eligible. Data were synthesized narratively. RESULTS:Of 166 records screened, 7 studies were included (1 experimental, 1 mixed, 5 clinical; 118 patients). Both experimental studies showed FNEC achieved tumoricidal efficacy comparable to LN (97.6% vs 90.4% bone shrinkage, p = 0.008) while causing less apoptosis in bone, muscle, and skin (15%-35% less tissue damage), and sustaining a lethal -122°C isotherm at 10-mm depth where LN's efficacy fell sharply (8.3% vs 100% stromal cell death at 5 mm). Across the clinical studies, no recurrence occurred in 4 studies (one did not report recurrence), and one cohort study recorded a 12.5% recurrence rate with 90.6% five-year recurrence-free survival. Perioperative complications were infrequent, ranging to 6.4%, and exclusively superficial; no study reported neurovascular injury. CONCLUSIONS:Clinicians can consider FNEC a lower-morbidity adjuvant alternative to LN in select cases, but should interpret this evidence cautiously. Every clinical study is observational, uncontrolled, and concentrated in a small number of Asia-Pacific institutions, with FNEC protocols unstandardized. Further research should prioritize multicenter randomized trials with standardized FNEC protocols and validated outcome instruments.
BACKGROUND:Obesity is a major determinant of technical difficulty in sentinel lymph node (SLN) mapping for endometrial cancer and has been associated with reduced bilateral detection and increased risk of empty nodal dissections. Whether a clinically relevant body mass index (BMI) threshold exists beyond which robotic assistance may preserve SLN mapping reliability remains unclear. METHODS:We conducted a retrospective cohort study including consecutive women with apparent early-stage endometrial cancer (FIGO 2009 I-II) and BMI ≥30 kg/m2 undergoing minimally invasive hysterectomy with bilateral salpingo-oophorectomy and indocyanine green-guided SLN mapping. Patients were stratified into class I obesity (BMI 30-34.9 kg/m2) and class II-III obesity (BMI ≥35 kg/m2). The primary endpoint was bilateral SLN detection at final pathology. Secondary endpoints included empty package dissection. Logistic regression models were fitted within the BMI ≥35 subgroup to explore independent predictors of bilateral detection and empty package dissection. RESULTS:A total of 109 patients were included (70 laparoscopic, 39 robotic). In class I obesity, bilateral SLN detection rates were comparable between approaches (70.0% vs 78.6%). In patients with BMI ≥35 kg/m2, robotic surgery showed higher bilateral detection compared with laparoscopy (88% vs 53.3%, p = 0.008). Empty package dissection occurred less frequently with robotics in this subgroup (8% vs 33.3%, p = 0.046). In multivariable analysis restricted to BMI ≥35 kg/m2, robotic approach was associated with increased odds of bilateral detection (OR 9.24, 95% CI 1.64-52.19, p = 0.012). CONCLUSIONS:In women with severe obesity, robotic surgery was associated with meaningful improvements in SLN mapping completeness compared with laparoscopy. These findings support the hypothesis that a BMI threshold may exist beyond which robotic assistance helps preserve nodal staging reliability, warranting validation in larger prospective studies.
BACKGROUND:Accurate lymph node (LN) classification is crucial for prognostic evaluation and individualized management in esophageal squamous cell carcinoma (ESCC). METHODS:We retrospectively analyzed 688 ESCC patients who underwent R0 resection without neoadjuvant therapy, dividing them into development (n = 461) and validation (n = 227) cohorts. The prognostic performance of Lymph Node Ratio (LNR) and Log Odds of Positive Lymph Nodes (LODDS) was compared against the AJCC N-staging system. Multivariable Cox regression models were used to identify independent predictors and construct nomograms for Overall Survival (OS) and Recurrence-Free Survival (RFS). Model performance was assessed via the C-index, time-dependent ROC curves, and Decision Curve Analysis (DCA). RESULTS:Multivariable analysis identified LODDS as a modestly improved prognostic factor compared to AJCC-N and LNR, exhibiting slightly improved discriminatory performance for OS (C-index: 0.687; Likelihood Ratio: 102.9) and RFS (C-index: 0.685; Likelihood Ratio: 107.8). Based on these findings, LODDS-incorporated nomograms were constructed. In the validation cohort, these nomograms displayed robust predictive accuracy, with 1-, 3-, and 5-year AUCs of 0.737, 0.765, and 0.788 for OS, and 0.689, 0.748, and 0.783 for RFS, respectively. Calibration plots showed excellent agreement between predicted and observed survival, and DCA confirmed that the LODDS-based nomograms provided greater net clinical benefit than traditional staging systems. CONCLUSION:Among the three staging systems evaluated, LODDS provided complementary prognostic information beyond conventional lymph node classifications and may improve postoperative risk stratification in ESCC patients. The proposed LODDS-based nomograms demonstrate robust predictive accuracy and clinical utility, serving as valuable tools for individualized postoperative management.
BACKGROUND:We aim to assess the surgical and oncological outcomes of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in upper rectal peritoneal metastases (U_PM) versus middle/lower rectal peritoneal metastases (ML_PM). METHODS:Between January 2013 and March 2024, Data from 101 patients with rectal peritoneal metastases who underwent CRS with or without HIPEC were analysed (U_PM, n = 68; ML_PM, n = 33). Day-30 morbi-mortality, overall survival (OS) and recurrence-free survival (RFS) were compared. RESULTS:Among 101 patients included, the median age was 58 years and 52.5% were women. Initial PCI score median was 6 [3; 13]. The U_PM group had longer surgery time (420 vs 370 min; p = 0.029). Surgical outcomes including postoperative complications, reoperation rate, ICU and hospital stays were not significantly different between U_PM and ML_PM groups. Severe complications (Dindo-Clavien 3-4) and death rates were similar between the two groups: (64.3% vs 75%; p = 0.399) and (1.5% vs 0%; p = 1.000); respectively. The 3-year and 5-year OS rates were 59.7% and 42% respectively and were significantly better for U_PM than for ML_PM patients: (68.1% vs 42.9%; p = 0.039) and (48.2% vs 32.2%; p = 0.044) respectively. Multivariable Cox proportional hazards analysis of survival up to 5 years identified ML_PM (HR = 1.93), PCI score (HR = 1.10) and HIPEC procedures with oxaliplatin (HR = 2.93) as significant risk factors of death. The 3 and 5-years RFS were similar between groups (p = 0.318) and (p = 0.376); respectively. CONCLUSION:Patients presenting with upper rectal PM who underwent CRS with or without HIPEC have similar surgical outcomes except total surgery time and have significantly better OS at 3 and 5 years than patients with middle/lower rectal PM. RFS at 3 and 5 years was comparable between the two groups. Middle/Lower origin and PCI score were identified as significant risk factors of death. The primary tumor location of patients with rectal PM is an important factor that should not be underestimated. Larger prospective studies are required to confirm findings.
BACKGROUND:While enhanced recovery after surgery (ERAS) and awake monitored anaesthesia care (MAC) have been described to promote same-day discharge (SDD) in conventional mastectomy, their application in reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) has not yet been established. We present our protocol and early experience with awake R-E-NSM. METHODS:In this retrospective pilot case series, from February 2026 to April 2026, all consecutive awake R-E-NSM performed at Tor Vergata University Hospital were retrieved from a prospectively maintained database (Approval number 62.25CET2-PTV) and reported according to the PROCESS guidelines. Eligible women were aged 18-70 years with cT0-2 cN0-1 breast cancer or known pathogenic genetic variants, scheduled for prepectoral reconstruction. Awake MAC was achieved through an opioid-free combination of ultrasound-guided regional anaesthesia. Primary outcomes of this preliminary analysis were the SDD rate and conversion to general anaesthesia (GA); secondary outcomes included operative time, postoperative length of stay (LOS), time to mobilisation, pain at rest (PAR) and movement-evoked pain (MEP), calculated with 48-h area under the curve (AUC) on numerical rating scale (NRS). RESULTS:12 awake R-E-NSM were performed in 10 patients, with a median age of 44.3 (38.7-69.2) years. No GA conversion was required. Surgical conversion for oncological reasons occurred in 2/12 (16.7%) cases. Median operative time was 210 (119-315) minutes. Median LOS was 12.0 (8.0-72.0) h; SDD was achieved in 9/10 (90%) patients, with discharge eligibility criteria met at 6 h. Median mobilisation time was 53.9 (24.6-115.1) minutes. PAR and MEP AUC were 196 (112-368) and 208 (132-382) NRS·h, respectively. The overall 30-day complication rate was 2/12 (16.7%), including one reoperation (NAC necrosis reoperation, 1/12, (8.3%) without implant loss. CONCLUSIONS:Awake R-E-NSM can be safely managed within an SDD protocol, with favourable early postoperative outcomes. Further studies are warranted to determine the impact of ERAS protocol on R-E-NSM.
BACKGROUND:Biliary tract cancer (BTC) is often diagnosed at an advanced stage. Para-aortic lymph node (PALN) metastasis represents distant disease and contraindicates curative resection. It is frequently occult on preoperative imaging and identified only at laparotomy, resulting in futile surgery. PALN sampling during staging laparoscopy (SL) may therefore be useful. We evaluated the feasibility and clinical impact of SL for BTC. METHODS:This retrospective single-centre study included 23 patients with perihilar or intrahepatic cholangiocarcinoma or gallbladder cancer without distant metastases on imaging who underwent SL between March 2024 and August 2025. SL was performed in patients requiring vascular resection, hepatopancreatoduodenectomy (HPD), or major hepatectomy with planned preoperative portal vein embolisation (PTPE), and in those before or during neoadjuvant therapy. Based on SL findings, treatment strategy was determined as curative surgery or systemic chemotherapy. SL included peritoneal washing cytology, assessment of peritoneal dissemination, and PALN sampling for permanent histology. RESULTS:Twenty-three patients underwent SL. PALN metastasis was detected in six patients (26.1%) and peritoneal dissemination in one (4.3%). Overall, seven patients (30.4%) avoided unnecessary laparotomies. One patient (4.3%) developed a Clavien-Dindo grade IIIa complication due to lymphatic leakage. Median operative time was 104 min (range, 61-151 min). Among patients with distant metastases detected on SL, the median time to chemotherapy initiation was 32 days (range, 14-60 days). CONCLUSIONS:SL with PALN sampling is feasible and safe for BTC, enabling the detection of distant metastases, and avoiding futile laparotomy, and facilitating a timely transition to systemic therapy.
BACKGROUND:Tumor regression grade (TRG) is widely used to evaluate pathological response after neoadjuvant chemotherapy (NAC) for locally advanced gastric cancer (LAGC), but it may not adequately reflect nodal response. We investigated the prognostic value of the lymph node response ratio (LNRR), a novel indicator of nodal response, and its complementary role to TRG. METHODS:We retrospectively analyzed 505 patients with clinically node-positive LAGC who underwent NAC followed by curative gastrectomy. LNRR was defined as the relative change between pretreatment clinically positive lymph node burden and postoperative pathological metastatic lymph node burden. Associations between LNRR, pathological response, and overall survival (OS) were evaluated using logistic regression, Kaplan-Meier analysis, Cox regression, and comparative prognostic performance analyses. RESULTS:LNRR was significantly associated with pathological response, with progressively higher values observed across worsening TRG categories (P < 0.001). In multivariable logistic regression, poor pathological response remained independently associated with high LNRR (TRG 2: OR 2.77, 95% CI 1.68-4.57; TRG 3: OR 3.19, 95% CI 1.88-5.39; both P < 0.001). Patients with high LNRR had significantly worse OS than those with low LNRR. On multivariable Cox analysis, high LNRR remained independently associated with inferior OS (HR 2.01, 95% CI 1.44-2.79; P < 0 0.001). Combined LNRR-TRG classification provided better prognostic discrimination than either parameter alone. Patients with high LNRR and poor TRG had the worst survival outcomes, whereas persistently high LNRR identified patients with unfavorable prognosis even among those with favorable TRG. CONCLUSIONS:LNRR reflects treatment-induced nodal response and provides prognostic information complementary to conventional TRG assessment. Combined evaluation of LNRR and TRG may improve postoperative risk stratification in patients with LAGC after NAC. Further validation in independent multicenter cohorts is warranted before routine clinical application.
BACKGROUND:Functional morbidity remains an important survivorship concern after sphincter-preserving surgery for very low rectal cancer. We evaluated factors associated with major low anterior resection syndrome (LARS) and fecal incontinence after ileostomy reversal following hand-sewn intersphincteric resection (ISR). METHODS:This retrospective cohort study included consecutive patients who underwent hand-sewn ISR with coloanal anastomosis and diverting ileostomy for low or ultralow rectal cancer at two tertiary centers between 2019 and 2024. Functional outcomes were assessed 12-15 months after ileostomy reversal using the LARS score and Wexner Fecal Incontinence Score. Major LARS was defined as a LARS score ≥30, and fecal incontinence severity was assessed using the Wexner score. Modified Poisson regression was used for major LARS, and multivariable linear regression with robust standard errors was used for Wexner score. RESULTS:Major LARS occurred in 61 of 128 patients (47.7%). The median LARS and Wexner scores were 29.0 (IQR, 20.0-34.0) and 9.0 (IQR, 6.0-11.2), respectively. Patients with major LARS had higher Wexner scores than those with no/minor LARS (12.0 vs 6.0; P < 0.001). In the adjusted major-LARS model, shorter tumor distance from the anal verge, neoadjuvant chemoradiotherapy (nCRT), and female sex were associated with major LARS. In adjusted Wexner regression, shorter tumor distance from the anal verge and nCRT were associated with higher Wexner scores. CONCLUSIONS:Major LARS was common, and continence impairment was observed after ileostomy reversal following hand-sewn ISR. Shorter tumor distance from the anal verge and nCRT showed consistent associations across major LARS and Wexner score outcomes.
