We read the recent article by Jin et al¹ with great interest. The study designed a multicenter randomized controlled trial to compare short-term radiotherapy plus neoadjuvant chemotherapy with chemoradiotherapy (CRT) followed by surgery and adjuvant chemotherapy in locally advanced rectal cancer. I wanted to share with you some points that worried me when I read the article from the perspective of a surgeon.

1. Abdominoperineal resection (APR) rates are generally below 10%. Even in centers that perform surgeries such as transanal total mesorectal excision (TME),² this rate may decrease to 2%. In a way I do not understand, why this rate is at the level of 45.1% in this article.
2. While extramural vascular invasion rates are in the range of 20%-30% in the general literature, it is stated as 53% in this article.³
3. Mesorectal fascia involvement with a rate of 56% is much higher than normal current information.³ When you look at the cT3 rates of the patients, it appears to be between 81% and 84%.
4. Locoregional recurrence rate (LRR): In the COLOR-2 study,⁴ the rate in patients who underwent laparoscopic and open TME was reported to be 5% in the third year and 4% in another study in which transanal TME was performed.⁵ The rate was seen as 8.4%-11% in this study.
5. How many of the patients with a pathological complete response of 21.8% in the total neoadjuvant therapy group and 12.3% in the CRT group underwent APR?
6. Why was the Hartman procedure performed in up to 5% of the patients? It should have been clarified.

中文翻译：

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局部晚期直肠癌的放化疗：外科医生的观点

我们以极大的兴趣阅读了 Jin 等人^{1最近发表的文章。}该研究设计了一项多中心随机对照试验，以比较局部晚期直肠癌的短期放疗加新辅助化疗与化放疗 (CRT) 后进行手术和辅助化疗。我想从外科医生的角度与您分享一些我在阅读这篇文章时所担心的观点。

1. 腹会阴切除术 (APR) 率一般低于 10%。即使在进行经肛门全直肠系膜切除术 (TME) 等手术的中心，²这一比率也可能降至 2%。在某种程度上我不明白，为什么这个比率在本文中处于 45.1% 的水平。
2. 虽然一般文献中的壁外血管侵犯率在 20%-30% 的范围内，但本文中规定为 53%。^3个
3. 直肠系膜筋膜受累率为 56%，远高于目前的正常信息。³当您查看患者的 cT3 率时，它似乎介于 81% 和 84% 之间。
4. 局部复发率 (LRR)：在 COLOR-2 研究中，据报道，接受腹腔镜和开放式 TME 的患者第三年的复发率为 5%，而在另一项进行经肛门 TME 的研究中为 4% ^。5在这项研究中，这一比率被视为 8.4%-11%。
5. 在总新辅助治疗组病理完全缓解率为 21.8% 和 CRT 组为 12.3% 的患者中，有多少人接受了 APR？
6. 为什么在多达 5% 的患者中进行了 Hartman 手术？它应该被澄清。