There are several benefits to the total neoadjuvant approach. It may allow for greater treatment compliance. Earlier delivery of full-dose, systemic therapy to eliminate micrometastatic disease has the potential to decrease the risk of disease progression during treatment and improve disease-related outcomes. Placing surgery as the final step in the treatment algorithm for locally advanced rectal cancer could also allow for earlier reversal of a diverting stoma postoperatively. Nevertheless, there are potential disadvantages to total neoadjuvant therapy. The delay in definitive surgery could allow local disease progression, particularly in those patients who do not respond to neoadjuvant chemotherapy. Neoadjuvant chemotherapy also may impact the performance status of patients who undergo planned surgical resection and/or potentially increase surgical complication rates.
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