A 62-year-old man with rectal cancer at 6 cm from the anal verge is staged cT3N1M0. After long-course chemoradiation, a restaging MRI shows mrTRG 3. The most appropriate surgical approach is:
- A Low anterior resection (LAR) with total mesorectal excision (TME) ✓
- B Abdominoperineal resection (APR)
- C Hartmann's procedure
- D Transanal endoscopic microsurgery (TEM) alone
Correct answer: A. Low anterior resection (LAR) with total mesorectal excision (TME)
Explanation
A tumour at 6 cm from the anal verge with mrTRG 3 (moderate response, intermediate residual disease) after neoadjuvant chemoradiotherapy can typically be addressed by LAR with TME, preserving the sphincter complex if an adequate distal margin and clear circumferential resection margin are achievable. APR is reserved for very low tumours involving the sphincters or where a negative distal margin cannot be obtained. TEM is used for selected ypT0-1 tumours after complete or near-complete clinical response.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.