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The FOxTROT trial evaluated whether giving a short course of chemotherapy before surgery could improve outcomes for patients with operable, locally advanced colon cancer. More than 1,000 patients were randomized to either immediate surgery followed by standard postoperative treatment or a perioperative strategy that started systemic chemotherapy before surgery and continued after resection. The study showed that preoperative treatment could be delivered safely in appropriately selected patients and was associated with more favorable pathological tumor regression and a lower burden of residual or recurrent disease at early follow-up. Importantly, the approach did not replace surgery; it was designed to integrate systemic therapy into the surgical pathway so that treatment of micrometastatic disease could begin earlier. For surgeons and multidisciplinary teams, the practical message is that the timing of chemotherapy is becoming an important part of colon-cancer management rather than a fixed “surgery first” sequence. Patient selection, staging and multidisciplinary coordination remain critical because not every patient with colon cancer requires or benefits from the same perioperative strategy.
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The FOxTROT trial evaluated whether giving a short course of chemotherapy before surgery could improve outcomes for patients with operable, locally advanced colon cancer. More than 1,000 patients were randomized to either immediate surgery followed by standard postoperative treatment or a perioperative strategy that started systemic chemotherapy before surgery and continued after resection. The study showed that preoperative treatment could be delivered safely in appropriately selected patients and was associated with more favorable pathological tumor regression and a lower burden of residual or recurrent disease at early follow-up. Importantly, the approach did not replace surgery; it was designed to integrate systemic therapy into the surgical pathway so that treatment of micrometastatic disease could begin earlier. For surgeons and multidisciplinary teams, the practical message is that the timing of chemotherapy is becoming an important part of colon-cancer management rather than a fixed “surgery first” sequence. Patient selection, staging and multidisciplinary coordination remain critical because not every patient with colon cancer requires or benefits from the same perioperative strategy.
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