Local resection <i>versus</i> watch and wait in patients with (near) clinical complete response after neoadjuvant chemoradiotherapy for mid-to-low rectal cancer: a retrospective cohort study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

QIU Xiaoyuan , SUN Zhen , XIAO Yi , QIU Huizhong , LIN Guole ,  LU Junyang

Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P. R. China;

Corresponding?author：

LU Junyang, Email: lujunyang@pumch.cn

Keywords：

rectal cancer; neoadjuvant chemoradiotherapy; clinical complete response; local excision; watch and wait

DOI：

10.7507/1007-9424.202606079

Video：

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Objective To explore the safety of local excision and watch and wait (W&W) strategy in patients with mid-low rectal cancer who achieved clinical complete response (cCR) or near-cCR after neoadjuvant chemoradiotherapy (nCRT). Methods We retrospectively reviewed patients with mid-low rectal cancer who achieved cCR or near-cCR after nCRT at Peking Union Medical College Hospital between July 2017 and July 2023 and divided them into two groups based on their treatment strategy: local excision group (n=30) and W&W group (n=37). The primary outcome was disease free survival (DFS), and the secondary outcomes were overall survival (OS), recurrence-free survival (RFS), and metastasis-free survival. Results Baseline characteristics (including age, gender, and so on) were balanced and comparable between the two groups (P>0.05). Postoperative pathology in the local excision group showed ypT0 in 16 cases (53.3%), ypT1 in 3 cases (10.00%), ypT2 in 10 cases (33.3%), and ypT3 in 1 case (3.3%). Among the 10 cases of cCR in the local excision group, 7 cases (70.0%) achieved a pathological complete response. Among the 20 cases of near-cCR in the local excision group, 9 cases (45.0%) achieved pathological complete response. The median follow-up time was 38 months (range, 2 to 74 months). In the W&W group, tumor regrowth occurred in 13 cases (35.1%), distant metastasis in 7 cases (18.9%), and cancer-related death in 4 cases (10.8%); in the local excision group, local recurrence occurred in 3 cases (10.0%), distant metastasis in 6 cases (20.0%), and cancer-related death in 3 cases (10.0%). The local recurrence/relapse rate was higher in the W&W group than that in the local excision group (χ²=5.758, P=0.016), while no significant differences were found in the distant metastasis rate (χ²=0.013, P=0.911) or mortality (χ²=0.012, P=1.000). The local excision group had superior DFS (HR=0.373, P=0.031) and RFS (HR=0.238, P=0.014) compared with the W&W group. However, no significant differences were found in OS (HR=0.780, P=0.745) or metastasis-free survival (HR=1.027, P=0.962). Conclusions In patients with mid-low rectal cancer who achieved cCR or near-cCR after nCRT, given the limited sample size and number of events in this study, local excision showed potential advantages in improving DFS and RFS, whereas OS, distant metastasis rate, and mortality were comparable between the two groups.

Citation： QIU Xiaoyuan, SUN Zhen, XIAO Yi, QIU Huizhong, LIN Guole, LU Junyang. Local resection versus watch and wait in patients with (near) clinical complete response after neoadjuvant chemoradiotherapy for mid-to-low rectal cancer: a retrospective cohort study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(8): 1064-1071. doi: 10.7507/1007-9424.202606079 Copy

1.	Benson AB, Venook AP, Adam M, et al. NCCN Guidelines^? Insights: Rectal Cancer, Version 3.2024 [J]. J Natl Compr Canc Netw, 2024, 22(6): 366-375.
2.	Hallam S, Messenger DE, Thomas MG. A systematic review of local excision after neoadjuvant therapy for rectal cancer: are ypT0 tumors the limit? [J]. Dis Colon Rectum, 2016, 59(10): 984-997.
3.	王姚蘭, 張純, 李玉潔, 等. 預防性造口與直腸癌術后低位前切除綜合征發生及發展軌跡的關系分析: 回顧性隊列研究 [J]. 中國普外基礎與臨床雜志, 2026, 33(7): 891-901.
4.	van der Valk MJM, Hilling DE, Bastiaannet E, et al. Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study [J]. Lancet, 2018, 391(10139): 2537-2545.
5.	Dattani M, Heald RJ, Goussous G, et al. Oncological and survival outcomes in watch and wait patients with a clinical complete response after neoadjuvant chemoradiotherapy for rectal cancer: a systematic review and pooled analysis [J]. Ann Surg, 2018, 268(6): 955-967.
6.	Sammour T, Price BA, Krause KJ, et al. Nonoperative management or ‘watch and wait’ for rectal cancer with complete clinical response after neoadjuvant chemoradiotherapy: a critical appraisal [J]. Ann Surg Oncol, 2017, 24(7): 1904-1915.
7.	Liu S, Zhong GX, Zhou WX, et al. Can endorectal ultrasound, MRI, and mucosa integrity accurately predict the complete response for mid-low rectal cancer after preoperative chemoradiation? A prospective observational study from a single medical center [J]. Dis Colon Rectum, 2018, 61(8): 903-910.
8.	De Nardi P, Carvello M. How reliable is current imaging in restaging rectal cancer after neoadjuvant therapy? [J]. World J Gastroenterol, 2013, 19(36): 5964-5972.
9.	Stijns RCH, de Graaf EJR, Punt CJA, et al. Long-term oncological and functional outcomes of chemoradiotherapy followed by organ-sparing transanal endoscopic microsurgery for distal rectal cancer: the CARTS Study [J]. JAMA Surg, 2019, 154(1): 47-54.
10.	Lezoche G, Baldarelli M, Guerrieri M, et al. A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy [J]. Surg Endosc, 2008, 22(2): 352-358.
11.	Perez RO, Habr-Gama A, S?o Juli?o GP, et al. Transanal local excision for distal rectal cancer and incomplete response to neoadjuvant chemoradiation-does baseline staging matter? [J]. Dis Colon Rectum, 2014, 57(11): 1253-1259.
12.	Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward [J]. Surg Endosc, 2010, 24(9): 2200-2205.
13.	Buess G, Theiss R, Hutterer F, et al. Transanal endoscopic surgery of the rectum - testing a new method in animal experiments [J]. Leber Magen Darm, 1983, 13(2): 73-77.
14.	中國直腸癌新輔助治療后等待觀察數據庫研究協作組, 中華醫學會外科學分會結直腸外科學組, 中國醫師協會結直腸腫瘤醫師專業委員會, 等. 直腸癌新輔助治療后等待觀察策略中國專家共識 (2024版) [J]. 中華胃腸外科雜志, 2024, 27(4): 301-315.
15.	Agachan F, Chen T, Pfeifer J, et al. A constipation scoring system to simplify evaluation and management of constipated patients [J]. Dis Colon Rectum, 1996, 39(6): 681-685.
16.	Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer [J]. Ann Surg, 2012, 255(5): 922-928.
17.	Juul T, Ahlberg M, Biondo S, et al. Low anterior resection syndrome and quality of life: an international multicenter study [J]. Dis Colon Rectum, 2014, 57(5): 585-591.
18.	Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data [J]. Lancet Oncol, 2010, 11(9): 835-844.
19.	Tulchinsky H, Rabau M, Shacham-Shemueli E, et al. Can rectal cancers with pathologic T0 after neoadjuvant chemoradiation (ypT0) be treated by transanal excision alone? [J]. Ann Surg Oncol, 2006, 13(3): 347-352.
20.	Martin ST, Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer [J]. Br J Surg, 2012, 99(7): 918-928.
21.	Marco MR, Zhou L, Patil S, et al. Consolidation mFOLFOX6 chemotherapy after chemoradiotherapy improves survival in patients with locally advanced rectal cancer: final results of a multicenter phase Ⅱ trial [J]. Dis Colon Rectum, 2018, 61(10): 1146-1155.
22.	Habr-Gama A, Perez RO, Nadalin W, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results [J]. Ann Surg, 2004, 240(4): 711-717; discussion 717-718.
23.	Beets GL, Figueiredo NL, Habr-Gama A, et al. A new paradigm for rectal cancer: organ preservation: introducing the International Watch & Wait Database (IWWD) [J]. Eur J Surg Oncol, 2015, 41(12): 1562-1564.
24.	Maas M, Beets-Tan RGH, Lambregts DMJ, et al. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer [J]. J Clin Oncol, 2011, 29(35): 4633-4640.
25.	Smith JJ, Strombom P, Chow OS, et al. Assessment of a watch-and-wait strategy for rectal cancer in patients with a complete response after neoadjuvant therapy [J/OL]. JAMA Oncol, 2019, 5(4): e185896. doi:10.1001/jamaoncol.2018.5896.
26.	Wang L, Zhang XY, Zhao YM, et al. Intentional watch and wait or organ preservation surgery following neoadjuvant chemoradiotherapy plus consolidation CAPEOX for MRI-defined low-risk rectal cancer: findings from a prospective phase 2 trial (PKUCH-R01 Trial, NCT02860234) [J]. Ann Surg, 2023, 277(4): 647-654.
27.	Wang Q, Zhang R, Xiao W, et al. The watch-and-wait strategy versus surgical resection for rectal cancer patients with a clinical complete response after neoadjuvant chemoradiotherapy [J/OL]. Radiat Oncol, 2021, 16(1): 16. doi: 10.1186/s13014-021-01746-0.
28.	Chadi SA, Malcomson L, Ensor J, et al. Factors affecting local regrowth after watch and wait for patients with a clinical complete response following chemoradiotherapy in rectal cancer (InterCoRe consortium): an individual participant data meta-analysis [J]. Lancet Gastroenterol Hepatol, 2018, 3(12): 825-836.
29.	Dossa F, Chesney TR, Acuna SA, et al. A watch-and-wait approach for locally advanced rectal cancer after a clinical complete response following neoadjuvant chemoradiation: a systematic review and meta-analysis [J]. Lancet Gastroenterol Hepatol, 2017, 2(7): 501-513.
30.	Cotti GC, Pandini RV, Braghiroli OFM, et al. Outcomes of patients with local regrowth after nonoperative management of rectal cancer after neoadjuvant chemoradiotherapy [J]. Dis Colon Rectum, 2022, 65(3): 333-339.
31.	Serra-Aracil X, Pericay C, Badia-Closa J, et al. Short-term outcomes of chemoradiotherapy and local excision versus total mesorectal excision in T2-T3ab, N0, M0 rectal cancer: a multicentre randomised, controlled, phase Ⅲ trial (the TAU-TEM study) [J]. Ann Oncol, 2023, 34(1): 78-90.
32.	Kennecke HF, O’Callaghan CJ, Loree JM, et al. Neoadjuvant chemotherapy, excision, and observation for early rectal cancer: the phase Ⅱ NEO trial (CCTG CO.28) primary end point results [J]. J Clin Oncol, 2023, 41(2): 233-242.
33.	Pucciarelli S, De Paoli A, Guerrieri M, et al. Local excision after preoperative chemoradiotherapy for rectal cancer: results of a multicenter phase Ⅱ clinical trial [J]. Dis Colon Rectum, 2013, 56(12): 1349-1356.
34.	D’Alimonte L, Bao QR, Spolverato G, et al. Long-term outcomes of local excision following neoadjuvant chemoradiotherapy for locally advanced rectal cancer [J]. Ann Surg Oncol, 2021, 28(5): 2801-2808.
35.	Rullier E, Rouanet P, Tuech J, et al. Organ preservation for rectal cancer (GRECCAR 2): a prospective, randomised, open-label, multicentre, phase 3 trial [J]. Lancet, 2017, 390(10093): 469-479.
36.	Aref A, Alame AM, Drelichman ER, et al. Should local excision after neoadjuvant therapy be included in the national guidelines for the treatment of locally advanced rectal cancer? [J]. Dis Colon Rectum, 2022, 65(4): 461-463.
37.	Geubels BM, Meyer VM, van Westreenen HL, et al. Role of local excision for suspected regrowth in a watch and wait strategy for rectal cancer [J/OL]. Cancers (Basel), 2022, 14(13): 3071. doi:10.3390/cancers14133071.
38.	Wang F, Chen G, Zhang Z, et al. The Chinese Society of Clinical Oncology (CSCO): clinical guidelines for the diagnosis and treatment of colorectal cancer, 2024 update [J]. Cancer Commun (Lond), 2025, 45(3): 332-379.
39.	Rullier E, Vendrely V, Asselineau J, et al. Organ preservation with chemoradiotherapy plus local excision for rectal cancer: 5-year results of the GRECCAR 2 randomised trial [J]. Lancet Gastroenterol Hepatol, 2020, 5(5): 465-474.
40.	Qiu X, Zhou J, Qiu H, et al. A new treatment strategy for mid-low rectal cancer patients exhibiting a clinical complete or near-complete response to neoadjuvant chemoradiotherapy: transanal endoscopic microsurgery-a multicenter prospective case-control clinical trial by MONT-R [J/OL]. Eur J Cancer, 2025, 216: 115156. doi: 10.1016/j.ejca.2024.115156.
41.	Ramirez JM, Elia M, Cordoba E, et al. Current controversies in transanal surgery for rectal cancer [J]. Surg Laparosc Endosc Percutan Tech, 2016, 26(6): 431-438.
42.	董家銘, 趙美姣, 楊曦. 多模態融合預測模型預測直腸癌全程新輔助治療后病理完全緩解 [J]. 中國普外基礎與臨床雜志, 2026, 33(7): 916-925.
43.	胡義銧, 劉碧瑤, 張雯迪, 等. 基于CT影像組學的局部進展期直腸癌新輔助放化療效果的預測模型研究 [J]. 中國普外基礎與臨床雜志, 2025, 32(2): 205-212.

1. Benson AB, Venook AP, Adam M, et al. NCCN Guidelines^? Insights: Rectal Cancer, Version 3.2024 [J]. J Natl Compr Canc Netw, 2024, 22(6): 366-375.
2. Hallam S, Messenger DE, Thomas MG. A systematic review of local excision after neoadjuvant therapy for rectal cancer: are ypT0 tumors the limit? [J]. Dis Colon Rectum, 2016, 59(10): 984-997.
3. 王姚蘭, 張純, 李玉潔, 等. 預防性造口與直腸癌術后低位前切除綜合征發生及發展軌跡的關系分析: 回顧性隊列研究 [J]. 中國普外基礎與臨床雜志, 2026, 33(7): 891-901.
4. van der Valk MJM, Hilling DE, Bastiaannet E, et al. Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study [J]. Lancet, 2018, 391(10139): 2537-2545.
5. Dattani M, Heald RJ, Goussous G, et al. Oncological and survival outcomes in watch and wait patients with a clinical complete response after neoadjuvant chemoradiotherapy for rectal cancer: a systematic review and pooled analysis [J]. Ann Surg, 2018, 268(6): 955-967.
6. Sammour T, Price BA, Krause KJ, et al. Nonoperative management or ‘watch and wait’ for rectal cancer with complete clinical response after neoadjuvant chemoradiotherapy: a critical appraisal [J]. Ann Surg Oncol, 2017, 24(7): 1904-1915.
7. Liu S, Zhong GX, Zhou WX, et al. Can endorectal ultrasound, MRI, and mucosa integrity accurately predict the complete response for mid-low rectal cancer after preoperative chemoradiation? A prospective observational study from a single medical center [J]. Dis Colon Rectum, 2018, 61(8): 903-910.
8. De Nardi P, Carvello M. How reliable is current imaging in restaging rectal cancer after neoadjuvant therapy? [J]. World J Gastroenterol, 2013, 19(36): 5964-5972.
9. Stijns RCH, de Graaf EJR, Punt CJA, et al. Long-term oncological and functional outcomes of chemoradiotherapy followed by organ-sparing transanal endoscopic microsurgery for distal rectal cancer: the CARTS Study [J]. JAMA Surg, 2019, 154(1): 47-54.
10. Lezoche G, Baldarelli M, Guerrieri M, et al. A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy [J]. Surg Endosc, 2008, 22(2): 352-358.
11. Perez RO, Habr-Gama A, S?o Juli?o GP, et al. Transanal local excision for distal rectal cancer and incomplete response to neoadjuvant chemoradiation-does baseline staging matter? [J]. Dis Colon Rectum, 2014, 57(11): 1253-1259.
12. Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward [J]. Surg Endosc, 2010, 24(9): 2200-2205.
13. Buess G, Theiss R, Hutterer F, et al. Transanal endoscopic surgery of the rectum - testing a new method in animal experiments [J]. Leber Magen Darm, 1983, 13(2): 73-77.
14. 中國直腸癌新輔助治療后等待觀察數據庫研究協作組, 中華醫學會外科學分會結直腸外科學組, 中國醫師協會結直腸腫瘤醫師專業委員會, 等. 直腸癌新輔助治療后等待觀察策略中國專家共識 (2024版) [J]. 中華胃腸外科雜志, 2024, 27(4): 301-315.
15. Agachan F, Chen T, Pfeifer J, et al. A constipation scoring system to simplify evaluation and management of constipated patients [J]. Dis Colon Rectum, 1996, 39(6): 681-685.
16. Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer [J]. Ann Surg, 2012, 255(5): 922-928.
17. Juul T, Ahlberg M, Biondo S, et al. Low anterior resection syndrome and quality of life: an international multicenter study [J]. Dis Colon Rectum, 2014, 57(5): 585-591.
18. Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data [J]. Lancet Oncol, 2010, 11(9): 835-844.
19. Tulchinsky H, Rabau M, Shacham-Shemueli E, et al. Can rectal cancers with pathologic T0 after neoadjuvant chemoradiation (ypT0) be treated by transanal excision alone? [J]. Ann Surg Oncol, 2006, 13(3): 347-352.
20. Martin ST, Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer [J]. Br J Surg, 2012, 99(7): 918-928.
21. Marco MR, Zhou L, Patil S, et al. Consolidation mFOLFOX6 chemotherapy after chemoradiotherapy improves survival in patients with locally advanced rectal cancer: final results of a multicenter phase Ⅱ trial [J]. Dis Colon Rectum, 2018, 61(10): 1146-1155.
22. Habr-Gama A, Perez RO, Nadalin W, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results [J]. Ann Surg, 2004, 240(4): 711-717; discussion 717-718.
23. Beets GL, Figueiredo NL, Habr-Gama A, et al. A new paradigm for rectal cancer: organ preservation: introducing the International Watch & Wait Database (IWWD) [J]. Eur J Surg Oncol, 2015, 41(12): 1562-1564.
24. Maas M, Beets-Tan RGH, Lambregts DMJ, et al. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer [J]. J Clin Oncol, 2011, 29(35): 4633-4640.
25. Smith JJ, Strombom P, Chow OS, et al. Assessment of a watch-and-wait strategy for rectal cancer in patients with a complete response after neoadjuvant therapy [J/OL]. JAMA Oncol, 2019, 5(4): e185896. doi:10.1001/jamaoncol.2018.5896.
26. Wang L, Zhang XY, Zhao YM, et al. Intentional watch and wait or organ preservation surgery following neoadjuvant chemoradiotherapy plus consolidation CAPEOX for MRI-defined low-risk rectal cancer: findings from a prospective phase 2 trial (PKUCH-R01 Trial, NCT02860234) [J]. Ann Surg, 2023, 277(4): 647-654.
27. Wang Q, Zhang R, Xiao W, et al. The watch-and-wait strategy versus surgical resection for rectal cancer patients with a clinical complete response after neoadjuvant chemoradiotherapy [J/OL]. Radiat Oncol, 2021, 16(1): 16. doi: 10.1186/s13014-021-01746-0.
28. Chadi SA, Malcomson L, Ensor J, et al. Factors affecting local regrowth after watch and wait for patients with a clinical complete response following chemoradiotherapy in rectal cancer (InterCoRe consortium): an individual participant data meta-analysis [J]. Lancet Gastroenterol Hepatol, 2018, 3(12): 825-836.
29. Dossa F, Chesney TR, Acuna SA, et al. A watch-and-wait approach for locally advanced rectal cancer after a clinical complete response following neoadjuvant chemoradiation: a systematic review and meta-analysis [J]. Lancet Gastroenterol Hepatol, 2017, 2(7): 501-513.
30. Cotti GC, Pandini RV, Braghiroli OFM, et al. Outcomes of patients with local regrowth after nonoperative management of rectal cancer after neoadjuvant chemoradiotherapy [J]. Dis Colon Rectum, 2022, 65(3): 333-339.
31. Serra-Aracil X, Pericay C, Badia-Closa J, et al. Short-term outcomes of chemoradiotherapy and local excision versus total mesorectal excision in T2-T3ab, N0, M0 rectal cancer: a multicentre randomised, controlled, phase Ⅲ trial (the TAU-TEM study) [J]. Ann Oncol, 2023, 34(1): 78-90.
32. Kennecke HF, O’Callaghan CJ, Loree JM, et al. Neoadjuvant chemotherapy, excision, and observation for early rectal cancer: the phase Ⅱ NEO trial (CCTG CO.28) primary end point results [J]. J Clin Oncol, 2023, 41(2): 233-242.
33. Pucciarelli S, De Paoli A, Guerrieri M, et al. Local excision after preoperative chemoradiotherapy for rectal cancer: results of a multicenter phase Ⅱ clinical trial [J]. Dis Colon Rectum, 2013, 56(12): 1349-1356.
34. D’Alimonte L, Bao QR, Spolverato G, et al. Long-term outcomes of local excision following neoadjuvant chemoradiotherapy for locally advanced rectal cancer [J]. Ann Surg Oncol, 2021, 28(5): 2801-2808.
35. Rullier E, Rouanet P, Tuech J, et al. Organ preservation for rectal cancer (GRECCAR 2): a prospective, randomised, open-label, multicentre, phase 3 trial [J]. Lancet, 2017, 390(10093): 469-479.
36. Aref A, Alame AM, Drelichman ER, et al. Should local excision after neoadjuvant therapy be included in the national guidelines for the treatment of locally advanced rectal cancer? [J]. Dis Colon Rectum, 2022, 65(4): 461-463.
37. Geubels BM, Meyer VM, van Westreenen HL, et al. Role of local excision for suspected regrowth in a watch and wait strategy for rectal cancer [J/OL]. Cancers (Basel), 2022, 14(13): 3071. doi:10.3390/cancers14133071.
38. Wang F, Chen G, Zhang Z, et al. The Chinese Society of Clinical Oncology (CSCO): clinical guidelines for the diagnosis and treatment of colorectal cancer, 2024 update [J]. Cancer Commun (Lond), 2025, 45(3): 332-379.
39. Rullier E, Vendrely V, Asselineau J, et al. Organ preservation with chemoradiotherapy plus local excision for rectal cancer: 5-year results of the GRECCAR 2 randomised trial [J]. Lancet Gastroenterol Hepatol, 2020, 5(5): 465-474.
40. Qiu X, Zhou J, Qiu H, et al. A new treatment strategy for mid-low rectal cancer patients exhibiting a clinical complete or near-complete response to neoadjuvant chemoradiotherapy: transanal endoscopic microsurgery-a multicenter prospective case-control clinical trial by MONT-R [J/OL]. Eur J Cancer, 2025, 216: 115156. doi: 10.1016/j.ejca.2024.115156.
41. Ramirez JM, Elia M, Cordoba E, et al. Current controversies in transanal surgery for rectal cancer [J]. Surg Laparosc Endosc Percutan Tech, 2016, 26(6): 431-438.
42. 董家銘, 趙美姣, 楊曦. 多模態融合預測模型預測直腸癌全程新輔助治療后病理完全緩解 [J]. 中國普外基礎與臨床雜志, 2026, 33(7): 916-925.
43. 胡義銧, 劉碧瑤, 張雯迪, 等. 基于CT影像組學的局部進展期直腸癌新輔助放化療效果的預測模型研究 [J]. 中國普外基礎與臨床雜志, 2025, 32(2): 205-212.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Local resection versus watch and wait in patients with (near) clinical complete response after neoadjuvant chemoradiotherapy for mid-to-low rectal cancer: a retrospective cohort study

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