Jabbar SAA, Choo ALE, Wong NW, Ngu JCY, Teo NZ. Comparing early surgical outcomes between total neoadjuvant therapy and standard long course chemoradiotherapy for rectal cancer. World J Gastrointest Oncol 2025; 17(11): 111250 [DOI: 10.4251/wjgo.v17.i11.111250]
Corresponding Author of This Article
Nan-Zun Teo, Assistant Professor, Consultant, FRCS (Ed), Department of General Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore. teo.nan.zun@singhealth.com.sg
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Surgery
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Retrospective Cohort Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 15, 2025 (publication date) through Nov 13, 2025
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World Journal of Gastrointestinal Oncology
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1948-5204
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Jabbar SAA, Choo ALE, Wong NW, Ngu JCY, Teo NZ. Comparing early surgical outcomes between total neoadjuvant therapy and standard long course chemoradiotherapy for rectal cancer. World J Gastrointest Oncol 2025; 17(11): 111250 [DOI: 10.4251/wjgo.v17.i11.111250]
World J Gastrointest Oncol. Nov 15, 2025; 17(11): 111250 Published online Nov 15, 2025. doi: 10.4251/wjgo.v17.i11.111250
Comparing early surgical outcomes between total neoadjuvant therapy and standard long course chemoradiotherapy for rectal cancer
Salman Ahmed Abdul Jabbar, Amadora Li En Choo, Neng-Wei Wong, James Chi-Yong Ngu, Nan-Zun Teo
Salman Ahmed Abdul Jabbar, Amadora Li En Choo, Neng-Wei Wong, James Chi-Yong Ngu, Nan-Zun Teo, Department of General Surgery, Changi General Hospital, Singapore 529889, Singapore
Author contributions: Jabbar SAA prepared and wrote the manuscript; Jabbar SAA, Choo ALE, Wong NW, Ngu JCY, and Teo NZ edited the manuscript; Jabbar SAA, Wong NW, Ngu JCY, and Teo NZ contributed to design and critical revision; Jabbar SAA and Teo NZ were involved in conceptualization; Choo ALE contributed to data collection; Teo NZ contributed to statistical analysis. All authors have read and agreed to the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Changi General Hospital (Approval No. 2023/2390).
Informed consent statement: Informed consent was obtained from all patients participating in the study.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nan-Zun Teo, Assistant Professor, Consultant, FRCS (Ed), Department of General Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore. teo.nan.zun@singhealth.com.sg
Received: June 27, 2025 Revised: July 12, 2025 Accepted: October 9, 2025 Published online: November 15, 2025 Processing time: 140 Days and 19.1 Hours
Abstract
BACKGROUND
Total neoadjuvant therapy (TNT) has been proposed as an advancement over standard long-course chemoradiotherapy (LCCRT) for the treatment of locally advanced rectal cancer (LARC). It has been suggested that TNT enhances resectability, improves treatment compliance, increases the rate of pathological complete response, and reduces the risk of systemic recurrence. However, concerns have been raised that the prolonged interval to surgery associated with TNT, particularly in regimens such as the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation (RAPIDO) protocol, may exacerbate fibrosis, leading to more technically challenging resections and poorer surgical outcomes.
AIM
To compare the early surgical outcomes of LARC patients treated with TNT-RAPIDO vs LCCRT.
METHODS
A single-center, retrospective cohort study was conducted of patients with LARC treated with TNT-RAPIDO or standard LCCRT followed by surgical resection between 2014 and 2024. A total of 99 patients with LARC were analyzed, including 29 treated with TNT-RAPIDO and 70 treated with standard LCCRT. Demographics, clinicopathological characteristics and early post-operative outcomes were compared between both groups.
RESULTS
Both groups were comparable in terms of demographics and clinicopathological characteristics. The median interval from initiation of neoadjuvant therapy to surgery was significantly longer in the TNT group compared to the LCCRT group (29.5 weeks vs 19.5 weeks, P < 0.001). Operative time and intraoperative complications were comparable. While the TNT group had a significantly higher lymph node harvest (40.7 vs 23.4, P < 0.001), the number of positive nodes was not significantly different. R0 resection rates were similar (93.1% vs 90%, P = 0.625). There was no difference in post-operative morbidity and 30-day mortality between both groups. The TNT group had a significantly shorter total stoma duration (27.1 weeks vs 42.5 weeks, P = 0.013) and a lower rate of permanent stoma formation (13.8% vs 35.7%, P = 0.013).
CONCLUSION
Compared with LCCRT, TNT-RAPIDO does not compromise operative time, complication rates, or oncological quality of resection and may confer a shorter total stoma duration and a lower permanent stoma rate.
Core Tip: Rectal cancer and preoperative induction therapy followed by dedicated operation has emerged as a total neoadjuvant therapy strategy with improved oncological and functional outcomes. The impact of total neoadjuvant therapy on operative difficulty and short-term surgical outcomes, compared with long-course chemoradiotherapy, remains an area of ongoing debate. This cohort study of 99 patients demonstrated that the Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation (RAPIDO) protocol does not increase surgical difficulty or compromise early surgical outcomes compared with long-course chemoradiotherapy. It may also confer a shorter total stoma duration and a lower permanent stoma rate.
