Total Neoadjuvant Therapy for Rectal Cancer: Impact on Surgical Outcomes and Pathology

In a meta-analysis of 11 randomized controlled trials involving 3,185 rectal cancer patients, researchers compared total neoadjuvant therapy (TNT) to standard long course chemoradiotherapy (LCRT). TNT did not significantly differ in mortality or major complications but increased the risk of breached total mesorectal excision (TME). However, TNT showed a lower risk of disease progression during neoadjuvant treatment. While TNT raised concerns about local recurrence, its systemic control benefits warrant further investigation to identify suitable candidates for this approach.