A Meta-analysis is conducted on the efficacy of total neoadjuvant therapy (TNT) in the treatment of locally advanced rectal cancer, in order to provide reference for clinical treatment decision-making.

By searching CNKI, Wanfang Data, Cochrane Library, PubMed and Embase databases from January 2003 to January 2021, all literatures comparing TNT with standard treatment (neoadjuvant chemoradiotherapy/preoperative short-course radiotherapy + total mesorectum excision + postoperative adjuvant chemotherapy collectively referred to as standard treatment) were collected. The trial group was TNT, and the control group was standard treatment. Qualified literatures were selected and literature quality was evaluated, relevant data and materials were extracted for Meta-analysis with RevMan 5.4 software.

A total of 3 352 patients in 14 literatures were included. There were 1 688 cases in the trial group and 1 664 cases in the control group. Compared to the control group, the rate of pathological complete response (pCR) in the trial group was higher (OR=1.87, 95% CI: 1.56-2.25, P<0.001), R0 resection rate was higher (OR=1.37, 95% CI: 1.07-1.76, P=0.01), disease-free survival (DFS) (HR=0.85, 95% CI: 0.74-0.98; P=0.02) and overall survival (OS) (HR=0.73, 95% CI: 0.62-0.85; P<0.001) were better. There were no significant differences in tumor descending stage, grade 3-4 adverse events, anus preserving rate, overall complications of operation, anastomotic fistula and incision infection between the two groups.

For patients with locally advanced rectal cancer, although TNT can’t significantly improve OS and DFS, it significantly improved the pCR rate and R0 resection rate, which is safe and feasible.