article · Surgical Oncology
A retrospective study comparing surgical approaches for low locally advanced rectal cancer between university centres in France and Morocco found distinct treatment pathways adapted to patient cohorts. Moroccan patients presented at a younger age with more advanced tumours, leading to higher rates of abdominoperineal resection rather than the sphincter-preserving procedures more frequently performed in France. To manage permanent stomas without relying on standard abdominal colostomies, surgical teams in Morocco frequently implemented pseudocontinent perineal colostomy, which was carried out in nearly two-thirds of their definitive stoma patients. Despite these differing operative choices and baseline patient characteristics, oncological outcomes remained comparable between the two cohorts. Rates of complete mesorectal excision, positive resection margins, major postoperative complications, and reoperations did not differ significantly, while three-year disease-free survival and overall survival rates were also statistically similar.
Rectal cancer care requires balancing tumour clearance with post-surgical quality of life and stoma acceptability. Comparing clinical practice across different healthcare settings shows that alternative reconstructive techniques, such as pseudocontinent perineal colostomy, can be effectively adapted to local patient populations without increasing major complication rates or compromising intermediate survival outcomes.
The research focuses on retrospective clinical practices and surgical decision-making rather than a proprietary technology or product. The findings could guide the development of surgical training programmes and hospital treatment protocols for colorectal units managing advanced rectal tumours. Beyond informing clinical adoption of alternative reconstructive techniques, the abstract does not indicate a commercial application pathway.
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ABSTRACT 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.
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DOI: 10.1016/j.suronc.2026.102557
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