Comment on: Non-operative management of mismatch repair-deficient (dMMR) / micro satellite instability-high (MSI-H) colorectal cancer treated with immunotherapy: systematic review and meta-analysis

Correspondence to: Yugui Lian (email: fcclianyg@zzu.edu.cn)

Department of Colorectal Surgery

The First Affiliated Hospital of Zhengzhou University

Zhengzhou

China

BJS, https://doi.org/10.1093/bjs/znaf284, published 17 February 2026

We read with great interest the systematic review and metaanalysis by Tan et al. on nonoperative management of dMMR/MSIH colorectal cancer treated with immunotherapy1. We appreciate the authors’ timely synthesis of this emerging field. However, we identified a critical error in study inclusion that severely compromises the validity of the analysis.The review incorrectly included 29 patients from the TORCH trial2, representing 14.71% of the pooled weight in the meta-analysis, as dMMR/MSIH cases. In fact, the TORCH trial was designed for pMMR/MSS locally advanced rectal cancer. The full publication confirms only 4 of 130 patients (3.1%) had dMMR/MSIH, all excluded from primary analysis and treated with nonCAPOX regimens2. This misclassification severely biases pooled outcomes including local relapse, recurrencefree survival, and organ preservation. We strongly urge the authors and journal to reanalyze data by either excluding the TORCH abstract or replacing it with the correct 4patient dMMR/MSIH subgroup. A corrected metaanalysis is essential to draw reliable conclusions on nonoperative management in this population.