Neoadjuvant chemotherapy does not improve disease-free survival compared to upfront surgery for locally advanced colon cancer, but shows benefits in feasibility and reduced need for adjuvant therapy.

• Three-year disease-free survival: 87% for upfront surgery vs. 83% for neoadjuvant chemotherapy (p=0.36).
• Reduced requirement for adjuvant chemotherapy in the neoadjuvant group (59% vs 73%, p=0.02).

Surgeons should consider tumor characteristics, particularly mismatch repair status, when assessing neoadjuvant treatments.

• Postoperative complications and quality of life were similar across both groups.