[Expert consensus on local excision strategy for rectal cancer patients achieving clinical complete response or near clinical complete response following neoadjuvant therapy (2026 version)].

This publication is a multidisciplinary Chinese expert consensus on the use of local excision as an organ-preserving strategy for rectal cancer after neoadjuvant therapy.

Key points:

• Context and rationale
  • With modern neoadjuvant regimens, more patients with locally advanced rectal cancer achieve clinical complete response (cCR) or near-complete response (ncCR).
  • For these patients, local excision is increasingly used as an alternative to radical total mesorectal excision (TME) to preserve the rectum and avoid permanent stomas.
• Evidence summary
  • Multiple studies are cited showing that, in carefully selected patients, local excision after neoadjuvant therapy can provide survival outcomes comparable to TME.
  • Advantages include lower risk of permanent stoma, better anal function, and improved quality of life.
• Development process
  • The consensus was developed using the Delphi method by a panel including gastrointestinal surgeons, gastroenterologists, medical oncologists, radiation oncologists, pathologists, and radiologists.
  • It integrates current international and Chinese data along with domestic clinical experience.
• Scope of the consensus

  The document systematically addresses:

  • Definitions of cCR and ncCR in this context.
  • Indications and patient selection criteria for local excision after neoadjuvant therapy.
  • Surgical standards and choice of technique for local excision.
  • Prevention and management of perioperative complications.
  • Pathologic assessment of the locally excised specimen.
  • Criteria and pathways for additional treatment (e.g., completion TME, adjuvant therapy) based on pathology and response.
  • Structured follow-up and surveillance strategies after local excision.
• Output
  • Nine formal recommendations are presented to guide standardized clinical practice and future research on rectal cancer organ-preservation strategies in China, specifically for patients treated with neoadjuvant therapy who achieve cCR or ncCR.