Is there a place for organ preservation in infiltrating rectal cancer?

Neoadjuvant chemoradiotherapy followed by total mesorectal excision is currently the standard of care for locally advanced rectal cancers. However, this therapeutic approach does not take into account response to neo-adjuvant treatment, which can go up to a pathologic complete response in 10-20% of the patients. Moreover, despite its efficacy in terms of local control and survival, radical surgery is associated with a significant risk of postoperative morbidity, anastomotic leakage, permanent stoma, impaired quality of life, bowel and genitourinary dysfunction. Based on these adverse events, new strategies of organ preservation have emerged recently. They include, in case of suspicion of complete tumor response, both "watch mad wait" strategy and local excision of the residual scar. They seem attractive options, both for patients and surgeons, in terms of postoperative results. But few high-quality studies are available and fears remain regarding oncologic results and reproducibility of published results. Before these strategies can be recommended, large prospective randomized studies are still needed. The aim of this review is to discuss these two options for organ preservation, based on the current literature, with a special focus on oncologic outcomes.