Total neoadjuvant therapy (TNT) with short-course radiotherapy shows promise for locally advanced rectal cancer patients.

• After a median follow-up of 6.5 years, locoregional recurrence was just 5.9% and distant metastasis occurred in 24.7% of curatively treated patients.
• Patients with complete clinical responses had exceptional outcomes: 0% experienced locoregional recurrence and only 3.7% had distant metastasis.

Surgeons should consider TNT strategies for better patient selection and outcomes.

• The distal resection margin was ≤10 mm in 8.3% of sphincter-saving surgeries, indicating improved surgical margins compared to previous studies.