The rates of total mesorectal excision (TME) are decreasing due to the increasing acceptance of the watch-and-wait approach in locally advanced rectal cancer. Neoadjuvant therapies are improving the rate of clinical complete responses (cCR), making organ preservation an attractive therapeutic approach for many patients.
1‐3 However, while achieving a cCR is the ideal outcome, a significant number of patients still require TME due to incomplete responses to neoadjuvant therapy. As the awareness of the watch-and-wait approach grows, there may be unintended consequences, such as an increased number of patients declining recommended surgery in hopes of achieving a cCR. Current data on the trend of declining rectal cancer surgeries and the clinical outcomes of these patients are limited, creating a knowledge gap that must be addressed to guide informed decision-making. …