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Objectives The aim of this study was to assess the impact of neoadjuvant chemo-radiotherapy (nCRT) on body composition in patients who subsequently underwent curative surgery for low rectal cancer.Methods Thirty-eight consecutive patients who underwent nCRT and subsequent laparoscopic proctectomy for locally advanced low rectal cancer have been studied.In all patients body composition was measured by computed tomography before and after nCRT.Pathology response on CRT,postoperative short-term outcome,overall and disease-free long-term survival were assessed.Results Twelve patients (31.5％) had skeletal muscle loss 2％ after nCRT.No correlation was found between changes in body composition and postoperative complications.Skeletal muscle loss after nCRT significantly correlated with a shorter 5-year disease-free survival.Conclusion Preliminary data suggests that skeletal muscle loss after nCRT negatively impacted on disease-free survival in patients with locally advanced rectal cancer.