Local excision. LE is considered essentially an excisional biopsy and the decision to observe the patient (only follow-up) or run a TME after LE depends on the histologic features. Patients with no neoplasia (pCR) or with minimal residual disease (ypT1 with tumor regression grade <3 margins and free) are followed with close follow-up. In the remaining cases it opts for a subsequent intervention of TME. Studies concerning LE after neoadjuvant treatment are numerous with the principal lack is to be retrospective, with a low number and definition is not always clear and concordant for mCR and cCR. In addition, all these studies include patients who can not be subjected to radical surgery due to medical comorbidities or who reject the radical surgical treatment, especially when it is expected the final packaging of a stoma. More recently were published prospective studies both phase 2 and phase 3 that have consistently shown that LE is a feasible approach with oncological results comparable to the standard approach.