[Clinical value of local excision in locally advanced rectal cancer under the context of neoadjuvant immunotherapy]

The integration of immunotherapy into neoadjuvant treatment for locally advanced rectal cancer has markedly increased complete response rates, offering greater potential for organ preservation. However, the reduced restaging accuracy after immunotherapy has limited the applicability of the watch-and-wait strategy. As an organ-preserving approach that enables residual lesion removal and pathological assessment, local excision not only reduces the risk of local regrowth associated with watch-and-wait, but also enables full-thickness tumor bed sampling to determine pathological stage, regression pattern, and molecular characteristics, thereby supporting risk stratification and individualized decision-making. Moving forward, local excision is expected to achieve precise, risk-adapted organ preservation by optimizing surgical timing and techniques, and integrating multimodal parameters including imaging, pathology, and the tumor microenvironment, ultimately attaining the dual aim of maximizing both oncologic efficacy and functional preservation.