Tailored-Surgery for Locally Advanced Rectal Cancer Based on 3D Mathematical Reconstruction Surgical Planner: Prospective Multicenter Study

Objective: To evaluate the feasibility of a 3D image processing and reconstruction system (3D-IPR) based on pelvic magnetic resonance imaging (MRI) for surgical planning of locally advanced rectal cancer (LARC) and recurrent pelvic rectal cancer (PRCR). Background: Achieving R0 resection is critical for prognosis in LARC and PRCR, but 2D imaging often limits precise surgical planning in complex pelvic anatomy. 3D reconstruction may enhance visualization and decision-making. Methods: In this prospective feasibility multicenter study, 37 patients with LARC or PRCR and threatened circumferential resection margins on MRI underwent surgical planning using 3D-IPR. This tool provides information on tumor localization, infiltration volume, and precise spatial relationships with adjacent structures. Outcomes included surgeon satisfaction, changes in surgical approach, and perioperative results. Results: A total of 56.7% of cases were primary rectal cancer and 43.2% were recurrent cancer. Satisfaction percentage of 3D-IPR to select the best surgical route was 100%. Minimally invasive techniques were employed in 40% of the surgeries. In 37.8% of cases, it was considered that the 3D-IPR changed the decision on the surgical attitude with respect to the neighboring organ with suspicion of infiltration. R0 resection was achieved in 75.7% of cases, with no perioperative mortality and a severe complication rate of 27%. Conclusions: A surgical planner based on 3D reconstruction using mathematical algorithms from pelvic MRI is feasible for performing tailored surgery for locally advanced rectal cancers and pelvic recurrence. Further research will show if this new tool reduces the morbidity and mortality rates, increasing the probability of R0 surgery, and increasing survival.