{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T10:44:09Z","timestamp":1747219449645,"version":"3.40.5"},"reference-count":21,"publisher":"Wiley","issue":"1-2","license":[{"start":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T00:00:00Z","timestamp":1697500800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Management for locally advanced rectal cancer (LARC) conventionally comprises long\u2010course chemoradiotherapy (LCCRT), total mesorectal excision (TME), and adjuvant chemotherapy. However, the RAPIDO study published in 2021 showed that total neoadjuvant therapy (TNT) led to better oncological outcomes without increased toxicity. We review the surgical and short\u2010term oncological outcomes of patients with high\u2010risk LARC who underwent TNT or LCCRT before TME.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with high\u2010risk LARC who underwent TNT or LCCRT before TME between 2021 and 2022 were reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010five patients (66%) had TNT as per RAPIDO whilst 18 underwent LCCRT. Median follow\u2010up was 16\u2009months (range 5\u201325). Of the patients who had TNT, median age was 65\u2009years old (range 44\u201379), 34 (97%) had clinical Stage 3 LARC and median height FAV was 5\u2009cm (range 0.5\u201314). Nine (26%) required a dose delay\/reduction due to treatment toxicity. Seven (50%) showed resolution of previously enlarged lateral nodes. Three (9%) had pathological complete response. Postoperative major morbidity was 23%, of which 4 patients required a reoperation. Six (17%) patients had disease\u2010related treatment failure, with two having disease progression during TNT, two developed local recurrence, and two developed distal metastasis following surgery. Median duration to surgery following completion of chemotherapy was significantly shorter with TNT (36\u2009days versus 74\u2009days) (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). There were no other significant differences in outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>TNT is clinically safe in high\u2010risk LARC patients with no significant difference to surgical and short\u2010term oncological outcomes compared to LCCRT, although a higher incidence of early surgical morbidity was observed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.18739","type":"journal-article","created":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T06:35:49Z","timestamp":1697610949000},"page":"175-180","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Surgical and short\u2010term oncological safety of total neoadjuvant therapy in high\u2010risk locally advanced rectal cancer"],"prefix":"10.1111","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9214-6204","authenticated-orcid":false,"given":"Yvonne 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Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prasad","family":"Palanisamy","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Singapore General Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0771-5063","authenticated-orcid":false,"given":"Emile K.","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Singapore General Hospital  Singapore 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