Abstract
<jats:title>Abstract</jats:title> <jats:p>Rectal cancer patients are increasingly treated pursuing organ preservation. Transanal minimally invasive surgery (TAMIS) or transanal endoscopic microsurgery (TEM) are commonly used surgical procedures for small tumours (T1) in which resection of the tumour only, without removing lymph nodes, seems safe. The shifting paradigm towards less extensive surgery led to the search for rectum-saving treatment schedules for intermediate-risk tumours, without compromising oncological outcome. When a good response is achieved after neoadjuvant treatment, local excision as a less extensive surgical option versus total mesorectal excision (TME) seems a feasible option. Identification of a cCR using different modalities remains important for patient selection. A local excision offers the benefit of a histopathological tumour staging and identifying a pathological complete response (ypCR). This chapter describes an overview of the different neoadjuvant treatment options, organ preservation rates, and outcomes in terms of survival and quality of life for local excision as an organ-preserving treatment.</jats:p>