Impact of different neoadjuvant therapies on surgical complications in rectal cancer

BACKGROUNDNeoadjuvant therapy is the standard treatment for locally advanced rectal cancer.Radiotherapy and chemotherapy can achieve tumor downstaging and improve local control. AIMTo investigate whether different types of neoadjuvant therapy increase the incidence of surgical complications.Core Tip: This retrospective study of 782 rectal cancer patients compared postoperative complications among those receiving neoadjuvant chemotherapy alone, chemoradiotherapy, or upfront surgery.Neoadjuvant therapy was associated with increased overall complications and markedly elevated anastomotic leakage risk in the absence of a defunctioning stoma.However, a defunctioning stoma reduced the leakage rates to levels comparable to those in patients without neoadjuvant treatment.Our findings emphasize that high-risk rectal cancer patients receiving neoadjuvant therapy should be actively managed with a defunctioning stoma to prevent anastomotic leakage, minimize severe surgical complications, and improve prognosis and quality of life.