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Clin Colon Rectal Surg
DOI: 10.1055/a-2771-7417
Review Article

Local Excision in the Era of Total Neoadjuvant Therapy

Authors

  • Anders C. Larsen

    1   Department of Gastrointestinal Surgery and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
    2   Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

  • Joceline V. Vu

    3   Department of Surgery, Richmond Veterans Affairs Medical Center, Richmond, Virginia, United States

Funding Information The authors have no financial disclosures to report.
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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.

Keywords

TNT - local excision - proctectomy - rectal cancer


Publication History

Article published online:
09 January 2026

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