Heavy ion radiotherapy has shown promising results in treating pelvic recurrence of rectal cancer. We report a case where a patient underwent robot-assisted low anterior resection with transanal mesorectal excision (TaTME) following heavy ion radiotherapy, owing to challenges associated with spacer placement.

Case presentation

A 54-year-old man was diagnosed with upper rectal cancer. He underwent robot-assisted low anterior resection. Eight courses of CapeOX were administered as postoperative adjuvant chemotherapy. Immediately after completion of adjuvant chemotherapy (8 months postoperatively), computer tomography (CT) scan revealed a 30-mm large nodule on the dorsal surface of the oral anastomotic intestine, which was detected by PET-CT. Given that the tumor had an indistinct border with the sacrum and its superior margin extended to the second sacrum, it was concluded that a combined sacral resection was not advisable, and heavy ion radiotherapy was indicated. Robot-assisted low anterior resection combined with TaTME was performed approximately 2 months after heavy particle radiotherapy (73.6 Gy (RBE)/16 sessions). CT scan conducted 3 months after irradiation revealed substantial shrinkage of the recurrent tumor.


Robot-assisted resection of exposed colon with TaTME after heavy ion radiotherapy is regarded as an effective strategy for treating locally recurrent rectal cancer.

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Author notes

Funding: No funding was provided for the preparation of the manuscript, nor did the authors participating in this project receive any form of compensation from any public or private entity.