Patients with rectal cancer who undergo total neoadjuvant therapy have significantly worse survival rates after liver surgery.

• Median overall survival is 48.7 months for total neoadjuvant therapy patients vs 99.5 months for those who didn’t (p = .01).
• Total neoadjuvant therapy is an independent predictor of decreased overall survival (hazard ratio 0.41).

Watch for higher rates of liver steatosis (30.8% vs 8.7%, p = .002), which may impact surgical outcomes.

Further research is required to find factors that contribute to poor outcomes in these patients.