Published online Apr 15, 2021. doi: 10.4251/wjgo.v13.i4.252
Peer-review started: September 10, 2020
First decision: November 3, 2020
Revised: January 11, 2021
Accepted: March 16, 2021
Article in press: March 16, 2021
Published online: April 15, 2021
Core Tip: This is a retrospective study to investigate prognostic factors for distant metastasis, especially early distant metastasis, using the standard treatment paradigm to identify the most effective treatments according to recurrence risk. Poorly differentiated tumors, involvement of mesorectal fascia, or presence of extramural involvement were associated with distant metastasis and early distant metastasis. For patients with these risk factors, early systemic chemotherapy could be beneficial. Selective use of neoadjuvant treatment other than the current standard treatment according to individualized risk factors is necessary.