A randomized trial evaluated the effectiveness of preoperative radiotherapy combined with total mesorectal excision (TME) in patients with resectable rectal cancer. The study included 1861 patients, with 1805 eligible for treatment. Patients were randomly assigned to either preoperative radiotherapy (5 Gy on five days) followed by TME or TME alone. The trial aimed to determine whether preoperative radiotherapy improved local control and survival. The two-year overall survival rate was 82.0% in the radiotherapy-plus-surgery group and 81.8% in the surgery-only group (P=0.84), indicating no significant difference in survival. However, the rate of local recurrence was significantly lower in the radiotherapy-plus-surgery group (2.4%) compared to the surgery-only group (8.2%) (P<0.001). This suggests that preoperative radiotherapy reduces the risk of local recurrence when combined with TME. The study found that preoperative radiotherapy improved local control, with a significant reduction in local recurrence rates. The results indicate that preoperative radiotherapy is beneficial in reducing local recurrence when used in conjunction with standardized TME. However, the study also noted that preoperative radiotherapy did not significantly affect distant recurrence rates. The trial demonstrated that standardized TME significantly reduces local recurrence, and preoperative radiotherapy further reduces this risk. The study was conducted with strict quality control measures, including standardized surgical techniques and pathological evaluations. The results support the use of preoperative radiotherapy combined with TME for resectable rectal cancer, as it improves local control and reduces the risk of local recurrence. The findings are consistent with previous studies showing that preoperative radiotherapy improves survival and local control in rectal cancer patients. The study highlights the importance of standardized surgical techniques and quality control in evaluating the effectiveness of adjuvant therapies.A randomized trial evaluated the effectiveness of preoperative radiotherapy combined with total mesorectal excision (TME) in patients with resectable rectal cancer. The study included 1861 patients, with 1805 eligible for treatment. Patients were randomly assigned to either preoperative radiotherapy (5 Gy on five days) followed by TME or TME alone. The trial aimed to determine whether preoperative radiotherapy improved local control and survival. The two-year overall survival rate was 82.0% in the radiotherapy-plus-surgery group and 81.8% in the surgery-only group (P=0.84), indicating no significant difference in survival. However, the rate of local recurrence was significantly lower in the radiotherapy-plus-surgery group (2.4%) compared to the surgery-only group (8.2%) (P<0.001). This suggests that preoperative radiotherapy reduces the risk of local recurrence when combined with TME. The study found that preoperative radiotherapy improved local control, with a significant reduction in local recurrence rates. The results indicate that preoperative radiotherapy is beneficial in reducing local recurrence when used in conjunction with standardized TME. However, the study also noted that preoperative radiotherapy did not significantly affect distant recurrence rates. The trial demonstrated that standardized TME significantly reduces local recurrence, and preoperative radiotherapy further reduces this risk. The study was conducted with strict quality control measures, including standardized surgical techniques and pathological evaluations. The results support the use of preoperative radiotherapy combined with TME for resectable rectal cancer, as it improves local control and reduces the risk of local recurrence. The findings are consistent with previous studies showing that preoperative radiotherapy improves survival and local control in rectal cancer patients. The study highlights the importance of standardized surgical techniques and quality control in evaluating the effectiveness of adjuvant therapies.