Local Excision in the Era of Total Neoadjuvant Therapy

Abstract Total neoadjuvant therapy (TNT) for rectal cancer has allowed for organ preservation in cases of complete response. At first, organ preservation was accomplished by a nonoperative approach that avoided proctectomy altogether. However, nonoperative management is not appropriate in cases where the patient does not have a complete response, in the setting of local recurrence, or in early-stage rectal cancer where TNT was not previously indicated. Local excision of rectal tumors paired with TNT expands organ preservation strategies, allowing for resection to address the primary tumor without the risks and negative functional effects associated with proctectomy. In this brief review, we discuss the role of local excision in concert with total neoadjuvant treatment for early-stage tumors, in an organ-preserving strategy for residual disease after total neoadjuvant treatment, and for local regrowth after total neoadjuvant treatment.