[Expert consensus on local excision strategy for rectal cancer patients achieving clinical complete response or near...

With the continuous optimization and widespread application of neoadjuvant therapy regimens, an increasing number of patients with locally advanced rectal cancer are achieving a clinical complete response (cCR) or near-clinical complete response (ncCR). For these patients, local excision (LE) has emerged as a crucial organ-preservation strategy. Multiple studies demonstrate that LE yields survival outcomes comparable to those of radical total mesorectal excision (TME) while significantly reducing the risk of a permanent stoma and preserving anal function, thereby enhancing patients' quality of life. Initiated by the Colorectal Surgery Group of the Chinese Society of Surgery (Chinese Medical Association), the Colorectal and Anal Surgery Committee of the Chinese Research Hospital Association, and the Super Minimal Invasive Surgery Collaborative Group of the Chinese Society of Digestive Endoscopy, a panel of multidisciplinary experts-ranging from gastrointestinal surgery, gastroenterology, medical oncology, and radiation oncology to pathology and radiology-developed this consensus using the Delphi method. This document is grounded in the latest domestic and international evidence as well as clinical experience. This consensus systematically outlines the core aspects of LE, including key definitions, indications, surgical standards and technique selection, complication management, postoperative pathological assessment, subsequent treatment decision-making, and follow-up strategies. Nine recommendations are proposed to provide guidance for the standardized implementation and clinical research of organ-preservation strategies regarding rectal cancer following neoadjuvant therapy in China.