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ESSO 45 | Organ preservation guides TNT use in low-lying rectal tumors
Sara Lonardi, MD, Veneto Institute of Oncology, Padua, Italy, comments on the role of organ preservation in rectal cancer management, emphasizing that while cure remains the ultimate goal, preserving organ functionality is critically important in low-lying tumors, where neoadjuvant therapy (TNT) is recommended even for earlier disease stages. For mid and high rectal cancers, non-operative management is not the primary objective, though watch-and-wait strategies may be considered in selected patients achieving clinical complete response with active treatment. However, conservative surgical approaches remain preferable when tumors are amenable to such intervention. This interview took place at the 2026 European Society of Surgical Oncology (ESSO) Annual Meeting in Madrid, Spain.
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Transcript
I believe that organ preservation is the ultimate goal. Well, cure is the ultimately goal, but organ preservation is absolutely relevant in the low-lying tumor where we have a risk of lose the functionality, the normal functionality. So, in this case, if I have a low-lying tumor, TNT is advised even with lower stages of disease. Otherwise, in all the other cases of mid and high rectal disease, probably the goal is not a non-operative management...
I believe that organ preservation is the ultimate goal. Well, cure is the ultimately goal, but organ preservation is absolutely relevant in the low-lying tumor where we have a risk of lose the functionality, the normal functionality. So, in this case, if I have a low-lying tumor, TNT is advised even with lower stages of disease. Otherwise, in all the other cases of mid and high rectal disease, probably the goal is not a non-operative management. Clearly, if we have a more ACTIVE treatment and we have 30%, more or less, of clinical complete response, watch and wait is a useful strategy. But it’s not the ultimate goal if we have a tumor that is amenable of a conservative surgery.
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