Personalized total neoadjuvant therapy for rectal cancer enhances patient quality of life and reduces bowel dysfunction compared to standard care.

• Watch-and-wait patients reported significantly lower rates of lower anterior resection syndrome (55.6% vs. 87.5%, p = 0.012) and major symptoms (29.6% vs. 58.3%, p = 0.039).
• Quality of life scores improved, notably in stool frequency (20.7 vs. 30.8, p = 0.009) and abdominal pain (5.8 vs. 14.1, p = 0.005).

Surgeons should consider personalized watch-and-wait protocols for eligible patients to improve post-treatment outcomes and satisfaction.