Postoperative chemotherapy
Adjuvant chemotherapy is recommended for all patients and initiated within 4 weeks following TME. The decision to use adjuvant chemotherapy and the timing of its initiation will be determined by the investigators in charge of chemotherapy based on each patient’s postoperative condition. The duration of adjuvant chemotherapy is about 4 months, resulting in a total chemotherapy period of 6 months. Both arms will receive adjuvant chemotherapy according to the pathological stage as follows: capecitabine or 5-FU with leucovorin (or leucosodium or levoleucovorin) for ypStages 0 to I and mFOLFOX 6 for ypStages II to III. In case of Stage IV confirmed before or at the time of surgery, additional treatment is determined by the institutional multidisciplinary team.