Pathologic complete response to TNT + camrelizumab for rectal cancer with surgical anus-preservation - case report and literature review

Sep 24, 2026

A case report evaluates total neoadjuvant therapy (TNT) combined with camrelizumab in a 26-year-old woman with locally advanced rectal cancer closely involving the anal orifice and left anal raphe (T4bN1bM0, IIIC). After neoadjuvant radiotherapy and immunotherapy, the tumor regressed with no nodal enlargement, and robotic ultra-low anterior resection with left lateral lymph node dissection achieved pathologic complete response without distal or radial margin involvement. The anus was preserved and the patient had no major complications after discharge. Follow-up continued without adjuvant chemotherapy; findings support TNT as a potential anus-preserving option where Miles’ resection is otherwise indicated.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

1. Introduction

2. Case presentation

Background and preoperative assessment

Treatment strategy (TNT + camrelizumab) and surgery

Postoperative findings and follow-up

3. Conclusion

TYPE Case Report PUBLISHED 04 July 2023 DOI 10.3389/fsurg.2023.1192569 EDITED BY Leonardo Bustamante-Lopez, Surgical Health Outcomes Consortium, Digestive Helath and surgery Institute, Adventhealth, United States REVIEWED BY Mohammad Zuhdy, Mansoura University, Egypt Roy Hajjar, Montreal University, Canada Leonardo Bustamante, University of Zulia, Venezuela *CORRESPONDENCE Zhengqiang Wei [1980900547@qq.com](1980900547@qq.com) RECEIVED 23 March 2023 ACCEPTED 17 May 2023 PUBLISHED 04 July 2023 CITATION Pi F, Tang G, Xie C, Cao Y, Yang S and Wei Z (2023) Pathologic complete response to TNT + camrelizumab for rectal cancer with surgical anus-preservation: case report and literature review. Front. Surg. 10:1192569 . doi: 10.3389/fsurg.2023.1192569 COPYRIGHT © 2023 Pi, Tang, Xie, Cao, Yang and Wei. This isan open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Pathologic complete response to TNT + camrelizumab for rectal cancer with surgical anuspreservation: case report and literature review Feng Pi, Gang Tang, Chaozheng Xie, Yukun Cao, Shilai Yang and Zhengqiang Wei* Department of Gastrointestinal Surgery, The First Afﬁliated Hospital of Chongqing Medical University, Chongqing, China Background: This case report demonstrates the efﬁcacy of total neoadjuvant therapy (TNT) based on pathological complete response (PCR) . We also discuss the surgical approach to preserving the anus and its perioperative management. Case presentaion: The patient was a 26-year-old woman, with blood in the stool and stool thinning for over two months. Preoperative examination revealed locally advanced rectal cancer invading the left anal raphe and enlarged lymph nodes adjacent to the left internal iliac vessels. The lesion was preoperatively classiﬁed as T4bN1bM0 IIIC. Considering the size and depth of the tumor, it was difﬁcult to have sufﬁcient margins for radical resection, and the tumor was too close to the anal oriﬁce. Considering the patient’s youth and strong desire to preserve the anus, it was decided to use TNT combined with a camrelizumab regimen. After the entire course of neoadjuvant radiotherapy, the tumor size signiﬁcantly reduced in ﬁbrotic manifestations, and no enlargement of the lymph nodes adjacent to the left internal iliac vessels was observed. She underwent robotic laparoscopic ultra-low anterior rectal resection, left lateral lymph node dissection, and temporary ileostomy, and no signiﬁcant residue was observed after all bowel tubes were taken for examination, nor was there cancerous involvement at the distal or radial cut edges, or metastasis. The patient was discharged nine days postoperatively, and no major complications were detected. Follow-up was performed without adjuvant chemotherapy. Conclusions: TNT may be a better surgical option for preserving the anus and for complete radical resection in patients with LARC for whom Miles’ resection is indicated. KEYWORDS anus-preserving, camrelizumab, chemoradiotherapy, locally advanced rectal cancer, total neoadjuvant therapy 1. Introduction Rectal cancer is a common disease worldwide, accounting for one-third of all colorectal cancers (1) . Local recurrence after rectal cancer surgery has historically exceeded 20% at 2 years, with locally invasive lesions harboring the highest risk (2) . Surgery is the cornerstone of rectal cancer treatment, and total mesorectal excision (TME) is the gold standard (3, 4) . However, for locally advanced rectal cancer (LARC), it is difﬁcult to accomplish the purpose of radical surgery using surgical excision alone, whi

FAQs

What treatment strategy was used to support anus preservation?

The report used total neoadjuvant therapy (TNT) combined with a camrelizumab regimen, aiming to downstage the tumor and enable radical surgery while preserving the anus.

What were the key preoperative and pathological outcomes?

The patient had locally advanced rectal cancer (classified as T4bN1bM0, IIIC). After neoadjuvant treatment, there was marked tumor reduction, no nodal enlargement, and no significant residue with no cancer involvement at distal or radial cut edges.

Was adjuvant chemotherapy given after surgery?

The patient was followed without adjuvant chemotherapy after discharge.

Sep 24, 2026

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