Peixoto RD. Letter to the Editor: Surgical safety of RAPIDO-style total neoadjuvant therapy - reassuring early outcomes with important nuances. World J Gastrointest Oncol 2026; 18(8): 116571 [DOI: 10.4251/wjgo.116571]
Corresponding Author of This Article
Renata D’Alpino Peixoto, MD, PhD, FAHA, Department of Medical Oncology, British Columbia Cancer, 600 West 10th Avenue, Vancouver V5Z4E6, British Columbia, Canada. renata.peixoto@bccancer.bc.ca
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Oncology
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letter
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Peixoto RD. Letter to the Editor: Surgical safety of RAPIDO-style total neoadjuvant therapy - reassuring early outcomes with important nuances. World J Gastrointest Oncol 2026; 18(8): 116571 [DOI: 10.4251/wjgo.116571]
World J Gastrointest Oncol. Aug 15, 2026; 18(8): 116571 Published online Aug 15, 2026. doi: 10.4251/wjgo.116571
Letter to the Editor: Surgical safety of RAPIDO-style total neoadjuvant therapy - reassuring early outcomes with important nuances
Renata D’Alpino Peixoto
Renata D’Alpino Peixoto, Department of Medical Oncology, British Columbia Cancer, Vancouver V5Z4E6, British Columbia, Canada
Author contributions: Peixoto RD wrote, revised the manuscript.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Corresponding author: Renata D’Alpino Peixoto, MD, PhD, FAHA, Department of Medical Oncology, British Columbia Cancer, 600 West 10th Avenue, Vancouver V5Z4E6, British Columbia, Canada. renata.peixoto@bccancer.bc.ca
Received: November 14, 2025 Revised: December 3, 2025 Accepted: January 6, 2026 Published online: August 15, 2026 Processing time: 258 Days and 9.6 Hours
Abstract
The increasing adoption of total neoadjuvant therapy (TNT) in the management of locally advanced rectal cancer has raised concerns regarding potential increases in surgical complexity and perioperative morbidity, particularly with Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation (RAPIDO)-style treatment strategies that involve prolonged intervals between radiation and surgery. The study by Jabbar et al, published in the recent issue of the World Journal of Gastrointestinal Oncology, comparing outcomes following induction chemotherapy-based TNT with those observed after standard long-course chemoradiotherapy. Across key oncologic and technical endpoints - including R0 resection rates, completeness of total mesorectal excision, and early postoperative complication rates - no clinically meaningful differences were observed between treatment approaches. Importantly, TNT did not translate into higher surgical difficulty or worse short-term morbidity, despite delayed operative timing. Moreover, certain stoma-related outcomes appeared favorable in patients treated with TNT. Collectively, these findings provide reassurance regarding the surgical safety of RAPIDO-style TNT as it becomes more widely implemented and highlight the importance of future prospective studies incorporating objective and standardized measures of operative complexity.
Core Tip: This letter highlights real-world data showing that Rectal Cancer and Preoperative Induction Therapy Followed by Dedicated Operation (RAPIDO)-style total neoadjuvant therapy does not appear to increase surgical difficulty or early postoperative morbidity compared with standard long-course chemoradiotherapy. Despite prolonged intervals before surgery, key oncologic and technical metrics - such as R0 resection, total mesorectal excision completeness, and complication rates - were maintained, while stoma-related outcomes may even improve. These findings offer reassurance as total neoadjuvant therapy becomes increasingly integrated into management of locally advanced rectal cancer and underscore the need for future prospective studies incorporating objective measures of operative complexity.
