Zhou SQ, Ke QH. Letter to the Editor: Total neoadjuvant therapy for locally advanced rectal cancer: Navigating beyond surgical outcomes to holistic patient-centered care. World J Gastrointest Oncol 2026; 18(8): 116559 [DOI: 10.4251/wjgo.116559]
Corresponding Author of This Article
Qing-Hua Ke, PhD, Chief Physician, Department of Chemoradiotherapy, Jingzhou No. 1 People’s Hospital and First Affiliated Hospital of Yangtze University, No. 10 Tianhu Road, Shashi District, Jingzhou 434000, Hubei Province, China. 3803354759@qq.com
Research Domain of This Article
Oncology
Article-Type of This Article
letter
Open-Access Policy of This Article
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/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Zhou SQ, Ke QH. Letter to the Editor: Total neoadjuvant therapy for locally advanced rectal cancer: Navigating beyond surgical outcomes to holistic patient-centered care. World J Gastrointest Oncol 2026; 18(8): 116559 [DOI: 10.4251/wjgo.116559]
World J Gastrointest Oncol. Aug 15, 2026; 18(8): 116559 Published online Aug 15, 2026. doi: 10.4251/wjgo.116559
Letter to the Editor: Total neoadjuvant therapy for locally advanced rectal cancer: Navigating beyond surgical outcomes to holistic patient-centered care
Shi-Qiong Zhou, Qing-Hua Ke
Shi-Qiong Zhou, Qing-Hua Ke, Department of Chemoradiotherapy, Jingzhou No. 1 People’s Hospital and First Affiliated Hospital of Yangtze University, Jingzhou 434000, Hubei Province, China
Author contributions: Zhou SQ and Ke QH contributed equally to the manuscript, designed and wrote the paper; all authors approved the manuscript and its submission to World Journal of Gastrointestinal Oncology.
AI contribution statement: We confirm that no AI software was used to generate any text content, research analysis or figures in this manuscript. For better readability and grammatical accuracy, we only adopted simple auxiliary tools for minor language polishing and grammar checking, without altering the core viewpoints, data analysis and original writing logic of the manuscript. We solemnly guarantee that all research content, conclusions and original expressions are independently completed by the authors.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Corresponding author: Qing-Hua Ke, PhD, Chief Physician, Department of Chemoradiotherapy, Jingzhou No. 1 People’s Hospital and First Affiliated Hospital of Yangtze University, No. 10 Tianhu Road, Shashi District, Jingzhou 434000, Hubei Province, China. 3803354759@qq.com
Received: November 14, 2025 Revised: January 15, 2026 Accepted: February 14, 2026 Published online: August 15, 2026 Processing time: 262 Days and 5.4 Hours
Abstract
Locally advanced rectal cancer (LARC) remains a major challenge in oncology, with traditional treatment centered on long-course chemoradiotherapy (LCCRT) followed by total mesorectal excision. However, this paradigm is limited by suboptimal chemotherapy compliance, persistent metastasis risk, and functional morbidity. Total neoadjuvant therapy (TNT), integrating systemic chemotherapy with chemoradiotherapy upfront, has emerged as a promising alternative, but concerns about surgical safety and complexity hinder its widespread adoption. The retrospective cohort study by Jabbar et al, published in the recent issue of the World Journal of Gastrointestinal Oncology, compared TNT-RAPIDO with standard LCCRT in 99 LARC patients, providing critical evidence on surgical feasibility, functional outcomes, and oncologic potential. This commentary summarizes the study’s core findings, discusses unresolved questions, and proposes future research directions including multicenter validation, long-term oncologic evaluation, patient-reported outcome assessment, and personalized treatment strategies. A concise comparison of key outcomes between TNT-RAPIDO and LCCRT is provided to facilitate quick comprehension of core findings. Emphasizing the shift toward holistic patient-centered care, these advancements aim to optimize both curative efficacy and quality of life for LARC patients.
Core Tip: Locally advanced rectal cancer treatment is evolving from surgery-centric to multimodal strategies, with total neoadjuvant therapy (TNT) gaining attention for balancing curability and function. Jabbar et al’s study confirms that TNT-RAPIDO is surgically safe, achieving comparable R0 resection rates to standard chemoradiotherapy while reducing stoma duration and permanent stoma risk. We highlight the study’s contributions to resolving TNT-related uncertainties and propose future directions: (1) Validating findings in multicenter cohorts; (2) Evaluating long-term oncologic outcomes; (3) Integrating patient-reported measures; and (4) Developing personalized regimens. This shift toward holistic care ensures locally advanced rectal cancer treatment prioritizes both survival and quality of life.
