Current and future perspectives in the management and treatment of colorectal cancer

In this editorial,we reviewed the article by Fadlallah et al that was recently published in the World Journal of Clinical Oncology.The article provided a comprehensive and in-depth view of the management and treatment of colorectal cancer(CRC),one of the leading causes of cancer-related morbidity and mortality worldwide.The article analyzed the therapeutic modalities and their sequencing,focusing on total neoadjuvant therapy for locally advanced rectal cancer.It highlighted the role of immunotherapy in tumors with high microsatellite instability or deficient mismatch repair,addressing recent advances that have improved prognosis and therapeutic response in localized and metastatic CRC.Innovations in surgical techniques,advanced radiotherapy,and systemic agents targeting specific mutational profiles are also discussed,reflecting on how they revolutionized clinical management.Circulating tumor DNA has emerged as a promising tool for detecting minimal residual disease,prognosis,and therapeutic monitoring,solidifying its role in precision oncology.This review emphasized the importance of technological and therapeutic advancements in improving clinical outcomes and personalizing CRC treatment.

Comparative efficacy analysis of laparoscopic-assisted transanal total mesorectal excision vs laparoscopic transanal mesorectal excision for low-lying rectal cancer

BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC.

Innovative approaches in predicting outcomes for rectal neuroendocrine tumors

Rectal neuroendocrine neoplasms pose significant challenges due to their varied presentations and prognoses.Traditional prognostic models,while useful,often fall short of accurately predicting clinical outcomes for these patients.This article discusses the development and implications of a novel prognostic tool,the GATIS score,which aims to enhance predictive accuracy and guide treatment strategies more effectively than current methods.Utilizing data from a large cohort and employing sophisticated statistical models,the GATIS score integrates clinical and pathological markers to provide a nuanced assessment of prognosis.We evaluate the potential of this score to transform clinical decision-making processes,its integration into current medical practices,and future directions for its develo-pment.The integration of genetic markers and other biomarkers could further refine its predictive power,highlighting the ongoing need for innovation in the management of rectal neuroendocrine neoplasms.

Multiparameter magnetic resonance imaging-based radiomics model for the prediction of rectal cancer metachronous liver metastasis

BACKGROUND The liver,as the main target organ for hematogenous metastasis of colorectal cancer,early and accurate prediction of liver metastasis is crucial for the diagnosis and treatment of patients.Herein,this study aims to investigate the application value of a combined machine learning(ML)based model based on the multiparameter magnetic resonance imaging for prediction of rectal metachronous liver metastasis(MLM).AIM To investigate the efficacy of radiomics based on multiparametric magnetic resonance imaging images of preoperative first diagnosed rectal cancer in predicting MLM from rectal cancer.METHODS We retrospectively analyzed 301 patients with rectal cancer confirmed by surgical pathology at Jingzhou Central Hospital from January 2017 to December 2023.All participants were randomly assigned to the training or validation queue in a 7:3 ratio.We first apply generalized linear regression model(GLRM)and random forest model(RFM)algorithm to construct an MLM prediction model in the training queue,and evaluate the discriminative power of the MLM prediction model using area under curve(AUC)and decision curve analysis(DCA).Then,the robustness and generalizability of the MLM prediction model were evaluated based on the internal validation set between the validation queue groups.RESULTS Among the 301 patients included in the study,16.28%were ultimately diagnosed with MLM through pathological examination.Multivariate analysis showed that carcinoembryonic antigen,and magnetic resonance imaging radiomics were independent predictors of MLM.Then,the GLRM prediction model was developed with a comprehensive nomogram to achieve satisfactory differentiation.The prediction performance of GLRM in the training and validation queue was 0.765[95%confidence interval(CI):0.710-0.820]and 0.767(95%CI:0.712-0.822),respectively.Compared with GLRM,RFM achieved superior performance with AUC of 0.919(95%CI:0.868-0.970)and 0.901(95%CI:0.850-0.952)in the training and validation queue,respectively.The DCA indicated that the predictive ability and net profit of clinical RFM were improved.CONCLUSION By combining multiparameter magnetic resonance imaging with the effectiveness and robustness of ML-based predictive models,the proposed clinical RFM can serve as an insight tool for preoperative assessment of MLM risk stratification and provide important information for individual diagnosis and treatment of rectal cancer patients.

Discovery of primary lung cancer following resection of rectal cancer lung metastasis:A case report

BACKGROUND Colorectal cancer(CRC)ranks high among the most common types of malignant tumors.The primary cause of cancer-related mortality is metastasis,with lung metastases accounting for 32.9%of all cases of metastatic CRC(MCRC).However,cases of MCRC in the lungs,which present concurrently with primary peripheral lung adenocarcinoma,are exceptionally rare.CASE SUMMARY This report describes the case of a 52-year-old female patient who,following a colonoscopy,was diagnosed with moderately differentiated adenocarcinoma based on rectal mucosal biopsy findings.A preoperative chest computed tomography scan revealed a ground-glass nodule in the right lung and a small nodule(approximately 0.6 cm in diameter)in the extramural basal segment of the left lower lobe,which suggested multiple lung metastases from rectal cancer.Subsequent treatment and follow-up led to a diagnosis of rectal cancer with left lung metastasis and peripheral adenocarcinoma of the lower lobe of the right lung.CONCLUSION This case report describes the therapeutic journey of a patient with lung metastasis from rectal cancer in addition to primary peripheral adenocarcinoma,thus underscoring the critical roles of multidisciplinary collaboration,personalized treatment strategies,and comprehensive patient rehabilitation guidance.

Magnamosis for rectal reconstruction in canines

BACKGROUND The magnamosis,a minimal invasive,suture-free procedure,has been used for digestive tract or vessel reconstruction,such as gastrointestinal anastomosis,bilioenteric anastomosis,and coronary artery bypass.Although some case reports have demonstrated the potential of magnamosis for the treatment of congenital rectal atresia(RA),they cannot provide strong evidence for its widespread application.AIM To assess the feasibility and safety of magnamosis in treating RA in dogs as compared to suturing anastomosis.The findings of this study can be beneficial in guiding the clinical application of magnamosis.METHODS Thirty-six dogs were randomly assigned to the magnamosis group(n=18)and the suturing anastomosis group(n=18).The rectum was freed laparoscopically in all dogs.In the magnamosis group,rectal anastomosis was performed using a pair of magnetic rings,while the suturing anastomosis group underwent a straight-sighted end-to-end rectal anastomosis with 4-0 absorbable sutures.The anastomosis time was recorded,and abdominal plain film examination was performed to locate the magnets until they were expelled postoperatively.Specimens of the anastomosis were evaluated at one month,three months,and six months after surgery.RESULTS The mean time for rectal anastomosis was significantly shorter in the magnamosis group(12.22±2.78 minutes)than the suturing anastomosis group(18.11±1.68 minutes).There was one incidence of anastomotic bleeding in the suturing anastomosis group,whereas no complication was recorded in the magnamosis group.The magnets were discharged post-surgery in 7.17±1.30 days in all the dogs.The histopathological examination revealed a smoother healing of anastomotic mucosa in the magnamosis group as compared to that in the suturing anastomosis group.Moreover,the fiber alignment was also more natural in the magnamosis group with minimal inflammation.CONCLUSION Rectal reconstruction using magnamosis is a feasible,safe,and effective alternative to suturing anastomosis in dogs,with the added benefit of faster and more natural healing of the anastomosis.

Risk factors,monitoring,and treatment strategies for early recurrence after rectal cancer surgery

Early recurrence(ER)following surgery for rectal cancer is a significant factor impacting patient survival rates.Tsai et al identified age,preoperative neoadjuvant therapy,length of hospital stay,tumour location,and pathological stage as factors influencing the risk of ER.Postoperative monitoring for ER should encompass a thorough medical history review,physical examination,tumour marker testing,and imaging studies.Additionally,noninvasive circulating tumour cell DNA testing can be utilized to predict ER.Treatment strategies may involve radical surgery,radiation therapy,chemotherapy,and immunotherapy.Through a comprehensive analysis of risk factors,the optimization of monitoring methods,and the development of personalized treatment strategies,it is anticipated that both the efficacy of treatment and the quality of life for rectal cancer patients with postoperative recurrence can be significantly improved.

Development and validation of a nomogram prediction model for overall survival in patients with rectal cancer

BACKGROUND Rectal cancer is prevalent and associated with substantial morbidity and mortality.AIM To develop a nomogram prediction model for overall survival(OS)in patients with rectal cancer by leveraging a comprehensive analysis of demographic,clinicopathological,haematological,and follow-up data to identify independent prognostic factors.METHODS We conducted a prospective cohort study in China involving rectal cancer patients and applied Cox regression and least absolute shrinkage and selection operator regression to assess the significance of various variables as independent prognostic factors for OS.The identified factors were integrated into a nomogram model,which was evaluated for predictive accuracy via the C-index,area under the curve(AUC),calibration curve,and decision curve analysis(DCA).RESULTS Multivariate analysis revealed independent predictors of OS,including the Karnofsky performance status,age,sex,TNM stage,chemotherapy,surgery,targeted therapy,β2-microglobulin,lactate dehydrogenase,and the neutrophil-to-lymphocyte ratio.The nomogram demonstrated a C-index of 0.80 for the training and validation cohorts,with AUC values indicating high predictive accuracy for 1-year,3-year,and 5-year OS.The calibration curves confirmed the model's excellent agreement with the observed survival rates,and DCA revealed the superior clinical utility of the nomogram over the TNM staging system.CONCLUSION In this study,a novel prognostic model that accurately predicts the OS of rectal cancer patients was developed.The model exhibited excellent discriminatory and calibration capabilities,thus offering a reliable tool for health care professionals to estimate patient survival.

Machine learning and deep learning to improve prevention of anastomotic leak after rectal cancer surgery

Anastomotic leakage(AL)is a significant complication following rectal cancer surgery,adversely affecting both quality of life and oncological outcomes.Recent advancements in artificial intelligence(AI),particularly machine learning and deep learning,offer promising avenues for predicting and preventing AL.These technologies can analyze extensive clinical datasets to identify preoperative and perioperative risk factors such as malnutrition,body composition,and radiological features.AI-based models have demonstrated superior predictive power compared to traditional statistical methods,potentially guiding clinical decisionmaking and improving patient outcomes.Additionally,AI can provide surgeons with intraoperative feedback on blood supply and anatomical dissection planes,minimizing the risk of intraoperative complications and reducing the likelihood of AL development.

GATIS score:An innovative prognostic score for rectal neuroendocrine neoplasms

In this article,we discussed the article by Zeng et al,published in a recent issue of the World Journal of Gastroenterology.The publication represents a significant advancement in the prognostic evaluation of rectal neuroendocrine neoplasms.The GATIS score is a single nomogram model that incorporates five key progno-stic factors:Tumor grade;T stage;tumor size;age;and the prognostic nutritional index.This innovation optimizes the prognostic process,delivering more accurate predictions of overall survival and progression-free survival compared to tradi-tional TNM staging and World Health Organization classification systems.The findings of the study were based on a retrospective analysis spanning 12 years and involving 1408 patients from 17 reference centers in China.In this editorial,we specifically examined the strengths and limitations of the study,the clinical implications of the GATIS score,and the questions arising from its conclusions.

Rectal ameboma:A new entity in the differential diagnosis of rectal cancer

We examined the case report written by Ke et al,describing a rare clinical case.In this editorial,we would like to emphasize the differential diagnosis of rectal masses through a rare case.We describe a case of ameboma,which manifested itself as a mass in the rectum in terms of imaging and rectoscopic features,in an immunocompetent patient who had complaints of constipation and rectal bleeding for weeks.The initial diagnosis suggested malignancy due to imaging and rectoscopic features,but the pathology report reported it as amoebiasis.After ten days of metronidazole and oral amebicide(diloxanide furoate)treatment,the patient’s symptoms and radiological findings were successfully regressed.

Predictive value of magnetic resonance imaging parameters combined with tumor markers for rectal cancer recurrence risk after surgery

BACKGROUND An increasing number of studies to date have found preoperative magnetic resonance imaging(MRI)features valuable in predicting the prognosis of rectal cancer(RC).However,research is still lacking on the correlation between preoperative MRI features and the risk of recurrence after radical resection of RC,urgently necessitating further in-depth exploration.AIM To investigate the correlation between preoperative MRI parameters and the risk of recurrence after radical resection of RC to provide an effective tool for predicting postoperative recurrence.METHODS The data of 90 patients who were diagnosed with RC by surgical pathology and underwent radical surgical resection at the Second Affiliated Hospital of Bengbu Medical University between May 2020 and December 2023 were collected through retrospective analysis.General demographic data,MRI data,and tumor markers levels were collected.According to the reviewed data of patients six months after surgery,the clinicians comprehensively assessed the recurrence risk and divided the patients into high recurrence risk(37 cases)and low recurrence risk(53 cases)groups.Independent sample t-test andχ2 test were used to analyze differences between the two groups.A logistic regression model was used to explore the risk factors of the high recurrence risk group,and a clinical prediction model was constructed.The clinical prediction model is presented in the form of a nomogram.The receiver operating characteristic curve,Hosmer-Lemeshow goodness of fit test,calibration curve,and decision curve analysis were used to evaluate the efficacy of the clinical prediction model.RESULTS The detection of positive extramural vascular invasion through preoperative MRI[odds ratio(OR)=4.29,P=0.045],along with elevated carcinoembryonic antigen(OR=1.08,P=0.041),carbohydrate antigen 125(OR=1.19,P=0.034),and carbohydrate antigen 199(OR=1.27,P<0.001)levels,are independent risk factors for increased postoperative recurrence risk in patients with RC.Furthermore,there was a correlation between magnetic resonance based T staging,magnetic resonance based N staging,and circumferential resection margin results determined by MRI and the postoperative recurrence risk.Additionally,when extramural vascular invasion was integrated with tumor markers,the resulting clinical prediction model more effectively identified patients at high risk for postoperative recurrence,thereby providing robust support for clinical decision-making.CONCLUSION The results of this study indicate that preoperative MRI detection is of great importance for predicting the risk of postoperative recurrence in patients with RC.Monitoring these markers helps clinicians identify patients at high risk,allowing for more aggressive treatment and monitoring strategies to improve patient outcomes.

Rectal neuroendocrine tumors: Can we predict their behavior?

Rectal neuroendocrine tumors(r-NETs)are the second most common type of neuroendocrine tumor in the gastrointestinal tract,with an increase in incidence in the last decades.They are low-grade tumors and,given their low risk of meta-stasis,current guidelines recommend endoscopic resection for small lesions.The GATIS predicting score,proposed by Zeng et al,represents an innovative model designed to predict individualized survival outcomes for patients with r-NETs,analyzing the relationship between clinicopathological features and patient prog-noses.The authors identified tumor grade,T stage,tumor size,age,and progno-stic nutritional index as key prognostic factors,demonstrating that the GATIS Score provides a more accurate prognosis assessment compared to the World Health Organization classification or the tumor-node-metastasis staging system.Nevertheless,further larger prospective studies are necessary,and the scientific community's efforts in this context should be directed toward developing interna-tional multicentric prospective studies,with the ultimate aim of accurately de-fining and understanding the behavior of these conditions.

Enhancing rectal cancer liver metastasis prediction:Magnetic resonance imaging-based radiomics,bias mitigation,and regulatory considerations

In this article,we comment on the article by Long et al published in the recent issue of the World Journal of Gastrointestinal Oncology.Rectal cancer patients are at risk for developing metachronous liver metastasis(MLM),yet early prediction remains challenging due to variations in tumor heterogeneity and the limitations of traditional diagnostic methods.Therefore,there is an urgent need for noninvasive techniques to improve patient outcomes.Long et al’s study introduces an innovative magnetic resonance imaging(MRI)-based radiomics model that integrates high-throughput imaging data with clinical variables to predict MLM.The study employed a 7:3 split to generate training and validation datasets.The MLM prediction model was constructed using the training set and subsequently validated on the validation set using area under the curve(AUC)and dollar-cost averaging metrics to assess performance,robustness,and generalizability.By employing advanced algorithms,the model provides a non-invasive solution to assess tumor heterogeneity for better metastasis prediction,enabling early intervention and personalized treatment planning.However,variations in MRI parameters,such as differences in scanning resolutions and protocols across facilities,patient heterogeneity(e.g.,age,comorbidities),and external factors like carcinoembryonic antigen levels introduce biases.Additionally,confounding factors such as diagnostic staging methods and patient comorbidities require further validation and adjustment to ensure accuracy and generalizability.With evolving Food and Drug Administration regulations on machine learning models in healthcare,compliance and careful consideration of these regulatory requirements are essential to ensuring safe and effective implementation of this approach in clinical practice.In the future,clinicians may be able to utilize datadriven,patient-centric artificial intelligence(AI)-enhanced imaging tools integrated with clinical data,which would help improve early detection of MLM and optimize personalized treatment strategies.Combining radiomics,genomics,histological data,and demographic information can significantly enhance the accuracy and precision of predictive models.

Treatment of benign rectal stricture caused by repeated anal insertion by endoscopy and balloon dilation:A case report

BACKGROUND Benign rectal strictures can be categorized as primary(disease-related)and secondary(surgical anastomosis-related).Secondary strictures arise from surgical complications,whereas primary strictures have diverse etiologies,including various inflammatory conditions.Benign strictures are usually managed by surgery and endoscopy.We present an unusual etiology of benign rectal stricture caused by the repeated insertion of foreign objects into the rectum for sexual purposes,resulting in rectal injury and subsequent chronic inflammation.CASE SUMMARY A 53-year-old man presented to the outpatient clinic of the Colorectal Surgery Department with symptoms of chronic constipation and bloody stools.The patient previously experienced rectal injury due to foreign object insertion for sexual purposes.Colonoscopy revealed benign circumferential narrowing of the rectum.He underwent treatment by endoscopic argon plasma coagulation and balloon dilation and follow-up as an outpatient for 4 months.A colonoscopy at the end of the follow-up period revealed no evidence of rectal stricture relapse.CONCLUSION A history of rectal injury,followed by chronic inflammation,should be considered in patients with benign rectal strictures.Management with endoscopic argon plasma coagulation and balloon dilation can prevent the need for surgical resection of benign rectal strictures.

Colon and rectal cancer:An emergent public health problem

Colorectal cancer ranks third globally,with a high mortality rate.In the United States,and different countries in Europe,organized population screenings exist and include people between 50 and 74 years of age.These screenings have allowed an early diagnosis and consequently an improvement in health indicators.Colon and rectal cancer(CRC)is a disease of particular interest due to the high global burden associated with it and the role attributed to prevention and early diagnosis in reducing morbidity and mortality.This study is a review of CRC pathology and includes the most recent scientific evidence regarding this pathology,as well as a diagnosis of the epidemiological situation of CRC.Finally,the recommendation from a public health perspective will be discussed in detail taking into account the context and the most current recommendations.

How useful is rectal endosonography in the staging of rectal cancer?

It is essential in treating rectal cancer to have adequate preoperative imaging,as accurate staging can influence the management strategy,type of resection,and candidacy for neoadjuvant therapy.In the last twenty years,endorectal ultrasound(ERUS) has become the primary method for locoregional staging of rectal cancer.ERUS is the most accurate modality for assessing local depth of invasion of rectal carcinoma into the rectal wall layers(T stage) .Lower accuracy for T2 tumors is commonly reported,which could lead to sonographic overstaging of T3 tumors following preoperative therapy.Unfortunately,ERUS is not as good for predicting nodal metastases as it is for tumor depth,which could be related to the unclear definition of nodal metastases.The use of multiple criteria might improve accuracy.Failure to evaluate nodal status could lead to inadequate surgical resection.ERUS can accurately distinguish early cancers from advanced ones,with a high detection rate of residual carcinoma in the rectal wall.ERUS is also useful for detection of local recurrence at the anastomosis site,which might require fine-needle aspiration of the tissue.Overstaging is more frequent than understaging,mostly due to inflammatory changes.Limitations of ERUS are operator and experiencedependency,limited tolerance of patients,and limited range of depth of the transducer.The ERUS technique requires a learning curve for orientation and identification of images and planes.With sufficient time and effort,quality and accuracy of the ERUS procedure could be improved.

Feasibility and limitations of combined treatment for lateral pelvic lymph node metastases in rectal cancer

Colorectal cancer ranks among the most commonly diagnosed cancers globally,and is associated with a high rate of pelvic recurrence after surgery.In efforts to mitigate recurrence,pelvic lymph node dissection(PLND)is commonly advocated as an adjunct to radical surgery.Neoadjuvant chemoradiotherapy(NACRT)is a therapeutic approach employed in managing locally advanced rectal cancer,and has been found to increase the survival rates.Chua et al have proposed a combination of NACRT with selective PLND for addressing lateral pelvic lymph node metastases in rectal cancer patients,with the aim of reducing recurrence and improving survival outcomes.Nevertheless,certain studies have indicated that the addition of PLND to NACRT and total mesorectal excision did not yield a significant reduction in local recurrence rates or improvement in survival.Consequently,meticulous patient selection and perioperative chemotherapy may prove indispensable in ensuring the efficacy of PLND.

Robotic rectal surgery: State of the art

Laparoscopic rectal surgery has demonstrated its superiority over the open approach, however it still has some technical limitations that lead to the development of robotic platforms. Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one. For this reason a review of all the literature examining robotic surgery for rectal cancer was performed. Two reviewers independently conducted a search of electronic databases (PubMed and EMBASE) using the key words &ldquo;rectum&rdquo;, &ldquo;rectal&rdquo;, &ldquo;cancer&rdquo;, &ldquo;laparoscopy&rdquo;, &ldquo;robot&rdquo;. After the initial screen of 266 articles, 43 papers were selected for review. A total of 3013 patients were included in the review. The most commonly performed intervention was low anterior resection (1450 patients, 48.1%), followed by anterior resections (997 patients, 33%), ultra-low anterior resections (393 patients, 13%) and abdominoperineal resections (173 patients, 5.7%). Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function. Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times. This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative, clinical outcomes and incidence of complications. In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultra-low anterior resections but this technical improvement seems not to provide, until now, any significant clinical advantages to the patients.

Neoadjuvant chemotherapy with capecitabine combined with oxaliplatin for mid-low locally advanced rectal cancer with negative mesorectal fascia:Long-term outcomes of a prospective trial(PKUCH-R03 trial)

Objective:To evaluate the safety and efficacy of neoadjuvant chemotherapy(NCT)in mid-low locally advanced rectal cancer with negative mesorectal fascia(MRF).Methods:This prospective,single-arm phaseⅡtrial was designed and conducted at Peking University Cancer Hospital.The patients who provided consent received 3 months of NCT(capecitabine and oxaliplatin,CapOX)followed by total mesorectal excision(TME).The primary endpoint was the rate of pathological complete response(pCR).Results:From January 2019 through December 2021,a total of 53 patients were enrolled,7.5%of whom experienced grade 3-4 adverse events during NCT.The pCR rate was 17.0%for the entire cohort,and the overall rate of postoperative complications was 37.7%(1.9%of gradeⅢa patients).The 3-year disease-free survival rate was 91.4%,and 23.5%(12/51)of the patients suffered from major low anterior resection syndrome(LARS).Postoperative complications were independently associated with major LARS.Conclusions:For patients with mid-low rectal cancer with negative MRF,3 months of NCT were found to yield a favorable tumor response with acceptable toxicity.With fair long-term survival,the NCT regimen could be associated with low rates of perioperative complications as well as acceptable anal function.