Neoadjuvant immunotherapy shows promise for rectal cancer, challenging traditional surgical approaches.

• In microsatellite instability-high (MSI-H) cases, clinical complete response rates hit 100%, allowing some patients to avoid surgery.
• For microsatellite stable (MSS) patients, post-treatment surgery rates ranged from 57.6% to 100%, with watch-and-wait strategies used in up to 27.1%.

The variability in treatment outcomes underscores the need for tailored patient selection and further clinical trials to guide practice.

• R0 resection rates reached 70% to 100% for MSS and 80% to 100% for MSI-H patients.