Rationale behind the rectum-sparing approach In order to avoid the morbidity and functional sequelae associated with neoadjuvant therapy followed by TME and based on excellent outcomes seen in patients with a pCR, it has been proposed that, in patients with a major clinical (mCR) or complete (cCR) response, you can opt for a conservative approach that includes preservation of the rectum. During recent years we are seeing a growing interest in these conservative approaches, as demonstrated by the increasing number of publications on this new therapeutic strategy that includes observation ("wait and see" policy) and local excision.