Letter to the Editor: Surgical safety of RAPIDO-style total neoadjuvant therapy - reassuring early outcomes with important nuances

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.