[Treatment choice of locally advanced low and middle rectal cancer after neoadjuvant chemoradiation]

Close observation or local excision have developed to be acceptable choices of managing rectal cancer patients who had a complete or major response to neoadjuvant chemoradiation. Indications of these rectum-preserving strategies, however, remain debatable due to inaccurate tumor staging after chemoradiation, apparent discrepancy between pathological and clinical complete responses, and uncertain lymph node status. Both responses to chemoradiation and original tumor staging must be considered to decide the treatment plan. For patients with major response to chemoradiation and with an original staging of cTis-2, a local excision is now acceptable with close postoperative observation or additive radical surgery according to pathological results. Otherwise, a standard radical surgery is still the treatment of choice. Post-radiation tumor evaluation can be employed for decision on sphincter preservation. A longer waiting time of 6-12 weeks before surgery is suggested.