Total neoadjuvant therapy (TNT) drastically reduces the risk of distant metastasis in locally advanced rectal cancer compared to traditional methods.

• 5-year locoregional recurrence rate is only 6%, and distant metastasis rate is 25%.
• Among 109 patients with clinical complete response (25%), there were no locoregional recurrences and just 13% had distant metastasis.

Rethink patient selection and consider TNT to optimize surgical outcomes in advanced rectal cancer cases.

• Distal resection margins (DRM) ≤10 mm occurred in just 8% of patients after sphincter-saving procedures.