Rectum preserving surgery in the era of neoadjuvant chemoradiotherapy

Neoadjuvant chemoradiotherapy (nCRT) and subsequent radical resection have become the standard care of locally advanced rectal cancer (LARC). However, conventional radical surgery is associated with high intra-and post-operative morbidities, and a temporary or permanent stoma in some cases, impaired sexual and urinary function, and it eventually impair the quality of life. “Rectum-preserving surgery” is a novel concept in the era of nCRT, which will maximally benefit patients through the minimized injuries. This strategy has been increasingly utilized in LARC following nCRT. Nevertheless, it lacks high-level evidence of evidence based medicine, and the long term oncological safety remains to be determined by larger, multicenter, randomized clinical trials. The crucial aspect of “rectum-preserving surgery” is to accurately evaluate the status of primary tumor and metastatic lymph nodes, and thus to selective patients who could benefit from this strategy most.