To investigate the impact of tumor regression grade (TRG) after neoadjuvant therapy on surgical quality and prognosis in patients with locally advanced rectal cancer (LARC) undergoing total mesorectal excision (TME).

A retrospective analysis was performed on the clinical data of 92 LARC patients who received total neoadjuvant therapy (TNT) plus laparoscopic TME from January 2020 to March 2024. According to the Dowrak/Rödel TRG (5-grade) standard, patients were divided into poor regression group (n=54, ≤50% fibrosis in tumor area, TRG0-TRG2) and good regression group (n=38, >50% fibrosis, TRG3-TRG4). Data were analyzed using SPSS 27.0. Normally distributed measurement data (perioperative indicators, etc.) were expressed as (±s) and compared by independent sample t test; enumeration data were expressed as [cases (%)] and analyzed by χ² test. Survival curves were plotted by Kaplan-Meier method, and survival differences were evaluated by Log-Rank test. P<0.05 was considered statistically significant.

There were no significant differences in operation time, first flatus time, hospital stay, or total complication rate between the two groups (P>0.05). The good regression group had fewer dissected lymph nodes and less intraoperative blood loss than the poor regression group (P<0.05). The 2-year disease-free survival rate was significantly higher in the good regression group than in the poor regression group (94.7% vs. 75.9%, P<0.05), while there was no significant difference in overall survival rate between the two groups (97.4% vs. 94.4%, P>0.05).

In LARC patients receiving laparoscopic TME after TNT, those with tumor regression showing >50% regional fibrosis have less intraoperative blood loss, fewer dissected lymph nodes, and a higher disease-free survival rate.