The impact of neoadjuvant chemotherapy on safety and long-term survival in patients with locally advanced colon cancer

Sep 23, 2026

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Neoadjuvant chemotherapy (NAC) is increasingly used for many cancers, yet its role in locally advanced colon cancer (LACC) remains uncertain. This retrospective study evaluated feasibility and efficacy in 1,879 colon-surgery patients (January 2015 to May 2019), including 143 receiving NAC. After 1:2 propensity score matching, NAC improved R0 resection (97.8% vs 92.5%) and increased 5-year disease-free survival (75.2% vs 63.4%). Severe postoperative complications and key recovery outcomes were comparable, while 5-year overall survival showed no significant difference.

LanguageEnglish

CategoryResearch & Report

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Pages12

Reading Time30 min

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Abstract

Background

Methods

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Introduction

Jian et al. World Journal of Surgical Oncology (2026) 24:143 [https://doi.org/10.1186/s12957-026-04264-z](https://doi.org/10.1186/s12957-026-04264-z) World Journal of Surgical Oncology RESEARCH Open Access The impact of neoadjuvant chemotherapy on safety and long-term survival in patients with locally advanced colon cancer Jinliang Jian1†, Mingfang Yan2†, Yangming Li1†, Changhua Zhuo1, Mingming Xie1, Zhenmeng Lin 1 and Wei Wei3* Abstract Background Neoadjuvant chemotherapy (NAC) has proven effective for various tumors and is increasingly being adopted as the standard of care for many cancer types. However, its role in the management of locally advanced colon cancer (LACC) remains uncertain. This study aims to evaluate the feasibility and efficacy of NAC in patients with LACC. Methods We retrospectively reviewed patient records from a prospective database of individuals who underwent colon surgery between January 2015 and May 2019. Among 1,879 patients, 143 received NAC. To minimize selection bias and ensure comparability between groups, a 1:2 propensity score matching (PSM) was performed between the NAC and upfront surgery groups. Results After matching, the NAC group included 134 patients and the upfront surgery group included 268 patients, showing no significant differences in baseline demographic and oncological characteristics. In the NAC group, 16 (11 . 9%) achieved a pathological complete response (TRG 0), 26 (19 .4%) had a moderate response (TRG 1), 55 (41 . 0%) showed a minimal response (TRG 2), and 37 (27 . 6%) had a poor response (TRG 3) . The R0 resection rate was higher in the NAC group at 97 . 8%(131/134) compared to 92 . 5%(248/268) in the upfront surgery group. The rates of severe postoperative complications, bowel function recovery, length of hospital stay, and 30-day readmission were similar between the groups. The 5-year disease-free survival (DFS) rate was significantly higher in the NAC group than in the upfront surgery group (75 . 2% vs. 63.4%, p = 0 . 034) . However, the 5-year overall survival (OS) rates were 80.4% in the NAC group and 76 . 3% in the upfront surgery group, with no statistically significant difference (p = 0 . 098) . Conclusion NAC increases R0 resection and 5-year DFS rates in LACC patients without elevating the risk of severe postoperative complications, demonstrating its safety and feasibility. Keywords Locally advanced colon cancer, Neoadjuvant chemotherapy, Disease-free survival, Overall survival, Postoperative complications, Tumor regression grade †Jinliang Jian, Mingfang Yan and Yangming Li contributed equally to this work. *Correspondence: Wei Wei [19959182586@163.com](19959182586@163.com) 1Department of Colorectal Surgery, NHC Key LaboratoryofCancerMetabolism, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China 2Department of Anesthesiology, NHC Key LaboratoryofCancerMetabolism, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China 3Department of Radiologic Diagnosis, NHC Key LaboratoryofCancerMetabolism, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s

FAQs

What clinical question does the study address about neoadjuvant chemotherapy in LACC?

It evaluates the feasibility and efficacy of neoadjuvant chemotherapy in patients with locally advanced colon cancer, focusing on safety and long-term survival outcomes.

How were patients compared between the NAC and upfront surgery groups?

Records were retrospectively reviewed, and a 1:2 propensity score matching was performed between the NAC group and the upfront surgery group to reduce selection bias and improve comparability.

Did NAC increase the risk of severe postoperative complications?

No. After matching, the rates of severe postoperative complications and several recovery-related outcomes were similar between the NAC and upfront surgery groups.

Which survival endpoints improved with NAC?

The 5-year disease-free survival rate was significantly higher in the NAC group (75.2% vs 63.4%), while 5-year overall survival did not differ significantly.

Sep 23, 2026

Upload by Jacob