AimNeoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer facilitates tumour downstaging and complete pathological response (pCR). The goal of neoadjuvant systemic chemotherapy (total neoadjuvant chemotherapy, TNT) is to further improve local and systemic control. While some patients forgo surgery, total mesorectal excision (TME) remains the standard of care. While TNT appears to be noninferior to nCRT with respect to short‐term oncological outcomes few data exist on perioperative outcomes. Perioperative morbidity including anastomotic leaks is associated with a negative effect on oncological outcomes, probably due to a delay in proceeding to adjuvant therapy. Thus, we aimed to compare conversion rates, rates of sphincter‐preserving surgery and anastomosis formation rates in patients undergoing rectal resection after either TNT or standard nCRT.MethodsAn institutional colorectal oncology database was searched from January 2018 to July 2023. Inclusion criteria comprised patients with histologically confirmed rectal cancer who had undergone neoadjuvant therapy and TME. Exclusion criteria comprised patients with a noncolorectal primary, those operated on emergently or who had local excision only. Outcomes evaluated included rates of conversion to open, sphincter‐preserving surgery, anastomosis formation and anastomotic leak.ResultsA total of 119 patients were eligible for inclusion (60 with standard nCRT, 59 with TNT). There were no differences in rates of sphincter preservation or primary anastomosis formation between the groups. However, a significant increase in conversion to open (p = 0.03) and anastomotic leak (p = 0.03) was observed in the TNT cohort.ConclusionIn this series TNT appears to be associated with higher rates of conversion to open surgery and higher anastomotic leak rates. While larger studies will be required to confirm these findings, these factors should be considered alongside oncological benefits when selecting treatment strategies.

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新辅助治疗策略对局部晚期直肠癌围手术期结局的影响

目的局部晚期直肠癌的新辅助放化疗 (nCRT) 有助于肿瘤降期和完全病理缓解 (pCR)。新辅助全身化疗（全新辅助化疗，TNT）的目标是进一步改善局部和全身控制。虽然有些患者放弃手术，但全直肠系膜切除术 (TME) 仍然是标准治疗方法。尽管就短期肿瘤学结果而言，TNT 似乎并不劣于 nCRT，但有关围手术期结果的数据却很少。包括吻合口瘘在内的围手术期发病率与肿瘤学结果的负面影响相关，这可能是由于延迟进行辅助治疗所致。因此，我们的目的是比较 TNT 或标准 nCRT 后接受直肠切除术的患者的转化率、保肛手术率和吻合形成率。方法检索了 2018 年 1 月至 2023 年 7 月期间的机构结直肠肿瘤数据库。纳入标准包括以下患者：接受过新辅助治疗和 TME 的组织学证实的直肠癌。排除标准包括非结直肠原发性患者、紧急手术患者或仅进行局部切除的患者。评估的结果包括转为开放手术、保留括约肌手术的比率、吻合口形成和吻合口漏。 结果 共有 119 名患者符合纳入条件（60 名患者接受标准 nCRT，59 名患者接受 TNT）。各组之间括约肌保留率或初次吻合形成率没有差异。然而，打开（p= 0.03) 和吻合口漏 (p= 0.03) 在 TNT 队列中观察到。结论 在该系列中，TNT 似乎与较高的开放手术转换率和较高的吻合口漏率相关。虽然需要更大规模的研究来证实这些发现，但在选择治疗策略时应将这些因素与肿瘤学益处一起考虑。