Treatment strategies for rectal cancer are evolving rapidly, including an increased use of total neoadjuvant (TNT) therapy and organ preservation approaches. The objective of this study was to describe the practices in 2024 within the centers affiliated to the French Association of Surgery (AFC).

The participating centers prospectively collected data for all patients treated for rectal adenocarcinoma with curative intent during the month of October 2024.

Analysis of medical records for 140 patients from 52 centers revealed that 84% of tumors were classified as cT3-4 and 68% were cN+. Neoadjuvant therapy was administered to 80% of patients, and 53% received TNT. Radical surgery was performed in 76% of patients, 47% of who were robotic-assisted. Eleven percent of patients underwent a delayed colo-anal anastomosis. Thirty-three percent of patients who underwent surgery for low rectal cancer had an abdominoperineal resection. The overall postoperative complication rate was 43%, 13% of which were severe, and mortality was zero. A pathologic complete response (ypT0N0) was observed in 21% of patients undergoing surgery, and in 25% after TNT. An organ preservation strategy was planned in 16% of patients and effectively implemented in 10%.

This survey attests to the widespread use of TNT in France, but organ preservation remains limited, highlighting the need for better dissemination of good practices and the development of specialized pathways to optimize patient selection for rectal preservation.