OBJECTIVE: To systematically review the efficacy and safety of total neoadjuvant therapy（TNT） for locally advanced rectal cancer

so as to provide new thinking and clinical evidence for the treatment decision-making of locally advanced rectal cancer. METHODS: Randomized controlled trials on comparison between TNT and standard treatment for locally advanced rectal cancer were collected by retrieving the Cochrane Library

PubMed

Embase

CNKI

Wanfang Data up to Jul. 2022. According to the inclusion and exclusion criteria

the eligible literature was screened for quality assessment

relevant data and information were extracted

and Meta-analysis was performed by using Stata 14.0 software. RESULTS: Totally 10 studies were selected

including 2 980 patients

with good literature quality and no publication bias. Results of Meta-analysis indicated that compared with the standard treatment group

patients in the TNT group had a higher pathological complete remission rate（RR=1.73

95%CI=1.45-2.06）

and patients in the TNT group had longer disease-free survival（HR=0.81

95%CI=0.70-0.95） and overall survival（HR=0.78

95%CI=0.65-0.93）

all with statistically significant differences（P<0.05）. The differences in the incidences of grade 3-4 adverse events（RR=1.27

95%CI=0.93-1.75） and surgical complications（RR=1.00

95%CI=0.88-1.14） between two groups were not statistically significant（P>0.05）. CONCLUSIONS: Compared with standard treatment

the TNT model can improve pathological complete remission rate

prolong disease-free and overall survival in patients with locally advanced rectal cancer

without increasing grade 3-4 adverse events or surgical complications.