ABSTRACT
Local recurrence has long been the Achilles heel of the surgical treatment of rectal cancer, with incidence figures of 20%–30% that were quite common. With optimal MRI staging, neoadjuvant chemoradiation in high-risk patients and good Total Mesorectal Excision (TME) surgery, local recurrence rates are down to 5%. Evidence is slowly emerging that in some patients, the good response to chemoradiation can be exploited to avoid major surgery as well as the associated short- and long-term morbidity. In these ‘organ preserving’ strategies, the response to chemoradiation is assessed after a long interval, and either the small remnant or scar is excised transanally or simply observed in case of a clinical complete response. There is very little randomised evidence in the literature of organ preservation approaches versus standard TME. Most reports are on retrospective and prospective cohort studies, sometimes with non-randomised comparison to standard TME surgery.
