Objective:

To evaluate the impact of axial tumor location on clinicopathological features and prognosis in rectal cancer using preoperative high-resolution pelvic MRI.

Approach:

• Study Design: Retrospective review of 380 rectal cancer patients who underwent radical resection between January 2017 and July 2023.
• Tumor Classification: Tumors were classified based on preoperative MRI images into mesenteric side (3–9 o’clock) and anti-mesenteric side (9–3 o’clock) groups.
• Data Comparison: Demographic, clinicopathological, surgical, and survival data were compared between the two groups.

Key Findings:

• 3-year local recurrence-free survival (LRFS) was significantly lower in the anti-mesenteric group (91.6%) compared to the mesenteric group (97.1%, P = 0.029).
• No significant differences in 3-year disease-free survival (83.2% vs. 82.1%, P = 0.832) or overall survival (85.6% vs. 81.7%, P = 0.501) between groups.
• Age, surgical procedure, pathological T stage, and pathological N stage were identified as independent prognostic factors for overall survival.

Interpretation:

Axial location of rectal tumors is significantly associated with local recurrence risk, particularly for anti-mesenteric tumors, which may inform surgical planning and postoperative surveillance.

Limitations:

• Single-center study may limit generalizability.
• Retrospective design may introduce selection bias.

Conclusion:

Anti-mesenteric rectal tumors are associated with a higher risk of local recurrence, and preoperative MRI assessment provides valuable information for surgical planning and monitoring.