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Neoadjuvant chemoradiation (CRT) for rectal cancer increasingly results in pathologic complete response (pCR) after surgery. These pCR-patients could undergo less invasive treatment,provided thatprognosis is favourable. We aimed to determine whether pCR-patients have better long-term outcome than patients without pCR.A Medline & Embase search revealed 28 articles, based on 17 datasets, reporting onprognosis for different response groups after CRT. Authors from 14/17 datasetsprovided individual patient data. Five-year local-recurrence (LR), distant-metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) were estimated with Kaplan-Meier-curves, with DFS asprimary outcome. With multivariate analyses, hazard ratios (HR) were calculated with 95% confidence intervals (CI) for the outcome measures, comparing pCR-patients with non-pCR-patients.Three thousand one hundred and five patients were included; 484 (16%) had pCR. Median follow-up was 46 months (range 0-187) for pCR-patients and 48 months (range 0-277) for nonpCR-patients. Five-year-DFS was 83% for pCR and 66% for non-pCR. HR for DFS is 0.54 (95%CI: 0.40-0.73). Five-year LR, DMFS and OS were significantly better for pCR-patients (all P < 0.0001). Multivariate analyses showed that adjuvant chemotherapy does not additionally improve DFS.Patients with pCR have significantly better outcome than patients without pCR. In these patients a less invasive treatment could be considered, for example omission of adjuvant chemotherapy or even organ sparing surgery.