While the findings of these studies were encouraging, the evidence of the efficacy of these approaches was still limited. Results shown that rectum preservation could be achieved in 64.8 to 90.0% of patients with acceptable local control. Several studies described the effect of local resection in patients who significantly downstage to nCRT for LARC. As growing interest has developed in rectum-sparing strategies, therefore, it has been proposed that those who are cCR or near-cCR undergo local resection as a rectum-preserving strategy and decide whether to preserve the rectum according to the post-local resection ypT stage combined with other factors to avoid non-pCR patients from entering negative W&W. But pCR and cCR might not be equivalent, at a median 24 month follow-up, tumor regrowth was found in 24.2% of patients who underwent W&W. On the other hand, radical resection usually requires the creation of a temporary or permanent stoma, negatively impacting patients' quality of life (QoL). As early as 2004, Habr-Gamma reported that for patients in clinical complete response (cCR) after nCRT for LARC, the “watch-and-wait (W&W)” strategy of rectum-preservation with close follow-up and salvage surgery, if necessary, could be implemented to safeguard oncologic efficacy and save costs for health-care systems. LARC after nCRT may have the potential to downstage the primary tumor and even sometimes induce a pathological complete response (pCR), which occurs in 10 ~ 30% of patients, which results in lower rates of local recurrence and increased survival rates. In recent years, neoadjuvant chemoradiotherapy (nCRT) combined with total mesorectal resection (TME) has become the standard treatment model for locally advanced rectal cancer (LARC). Local resection can be a management option in selected patients with middle-low rectal cancer after nCRT for LARC and without loss of oncological safety at five years. The median follow-up times were 44.0 months (interquartile range = 4–107 months). One thousand six hundred ninety-three patients underwent radical resection after nCRT, and another 60 patients performed local resection. Partial patients with a significant downstage of the tumor were offered management with the local resection approach, and most of the rest were offered radical resection if eligible. This was a propensity-score matched cohort analysis study that included patients of all ages diagnosed with locally advanced rectal cancer (LARC) who had received neoadjuvant chemoradiotherapy (nCRT) at the Fujian Medical University Union Hospital and Fujian Medical University Affiliated Zhangzhou Hospital, China, between Jan 10, 2011, to Dec 28, 2021. We aimed to address the shortage of evidence regarding the safety of the local resection approach by comparing long-term oncological outcomes between patients managed by local resection and those who underwent radical resection.
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