Surgery 2026

Immune checkpoint inhibitors (ICIs) have transformed management of mismatch-repair-deficient rectal cancer, but their value when added to neoadjuvant chemoradiotherapy (CRT) or total neoadjuvant therapy (TNT) in mismatch-repair-proficient (pMMR) disease, which comprises most rectal cancers, remains unclear. We performed a comparative meta-analysis to quantify this benefit. Relevant databases were searched and data extracted from 11 studies (9 randomized trials, 2 single-arm phase II studies; 21 treatment arms) evaluating ICI-containing neoadjuvant regimens in pMMR rectal cancer. Random-effects (DerSimonian-Laird) risk-ratio meta-analyses compared eight studies with an immunotherapy-containing arm against a non-immunotherapy control across six outcomes: pathological complete response (pCR), major pathological response (MPR), clinical complete response (cCR), R0 resection, anal sphincter preservation, and grade 3-4 adverse events. A supplementary single-arm analysis pooled pCR across all 13 immunotherapy-containing arms. Adding immunotherapy significantly increased pCR (risk ratio [RR] 1.59, 95% CI 1.23-2.05; p

Adewale Ayeni is a Specialty Registrar (Higher Surgical Trainee) in General Surgery with the West Midlands Deanery, UK. He holds an MD, an MSc in International Public Health (Liverpool John Moores University), an MBA (University of East London), and is a Fellow of the Royal College of Surgeons of England. With over a decade of surgical experience across Nigeria and the UK, including senior registrar posts in colorectal, upper gastrointestinal, and oncoplastic breast surgery, he is an active researcher and teacher with multiple peer-reviewed publications in colorectal surgery, and is working toward a consultant colorectal surgery career in the UK.