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World J Clin Oncol. Aug 24, 2026; 17(8): 123375
Published online Aug 24, 2026. doi: 10.5306/wjco.123375
Near-complete clinical response after neoadjuvant therapy in rectal cancer: Decision-making between organ preservation and surgery
Thanat Tantinam, Kullawat Bhatanaprabhabhan, Boonchai Ngamsirimas, Pawit Sutharat, Rangsima Thiengthiantham, Nataphon Santrakul, Suwan Sanmee, Ekkarin Supatrakul, Punnawat Chandrachamnong, Suradet Buakhrun
Thanat Tantinam, Surgical Unit, Phatthalung Hospital, Mueang Phatthalung 93000, Phatthalung, Thailand
Thanat Tantinam, Kullawat Bhatanaprabhabhan, Boonchai Ngamsirimas, Rangsima Thiengthiantham, Nataphon Santrakul, Punnawat Chandrachamnong, Suradet Buakhrun, Division of Colorectal Surgery, Department of Surgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Krung Thep Maha Nakhon, Thailand
Thanat Tantinam, Pawit Sutharat, Suwan Sanmee, Ekkarin Supatrakul, Division of Colorectal Surgery and Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
Author contributions: Tantinam T and Buakhrun S contributed to interpretation of the data, and drafting of the manuscript; Tantinam T, Bhatanaprabhabhan K, Ngamsirimas B, Sutharat P, Thiengthiantham R, Santrakul N, Sanmee S, Supatrakul E, Buakhrun S, and Chandrachamnong P contributed to the conception and design of the study, critical revision of important intellectual content of the manuscript, and provision of final approval of the version to be published. All authors have read and approved the final version of the manuscript.
AI contribution statement: An AI tool (Claude, Anthropic, Sonnet 5) was used during the preparation of this manuscript. No portion of the main text was AI-generated; the investigators authored all content and conclusions. The AI tool was used only for language polishing and formatting assistance in the responses to reviewers; it was not used for translation, data analysis, or independent writing assistance. As this is a minireview, no formal study design was involved; the selection, synthesis, and interpretation of the literature were performed entirely by the authors, with no AI involvement. No images in the manuscript were AI-generated. All AI-assisted text was critically reviewed, verified, and edited by the authors, who take full responsibility for the accuracy and integrity of the content.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Suradet Buakhrun, MD, Consultant, Lecturer, Division of Colorectal Surgery, Department of Surgery, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit, Bangkok 10300, Krung Thep Maha Nakhon, Thailand.
suradet@nmu.ac.th
Received: May 19, 2026
Revised: July 10, 2026
Accepted: July 28, 2026
Published online: August 24, 2026
Processing time: 100 Days and 18.4 Hours
Near-complete clinical response (nCR) after neoadjuvant therapy in rectal cancer represents a clinically relevant but heterogeneous intermediate state between clinical complete response and incomplete clinical response. With the growing adoption of total neoadjuvant therapy, nCR is increasingly encountered; however, its optimal management remains controversial, particularly regarding its definition, timing of assessment, and the balance between organ preservation and oncologic safety. This mini-review synthesizes current evidence regarding the definition of nCR, the associated diagnostic challenges, and multimodal assessment techniques, including endoscopy, magnetic resonance imaging, and clinical examination. Particular emphasis is placed on second restaging, which enables dynamic evaluation of tumor regression and may facilitate conversion to clinical complete response in selected patients. Emerging evidence suggests that nCR comprises two biologically distinct subgroups - favorable and unfavorable - with oncologic risk determined by response trajectory rather than by observation duration alone. Management strategies include continued observation, immediate resection, and, in selected cases, local excision. We propose a practical management algorithm integrating patient preference, response patterns, and restaging findings to guide individualized decision-making. A critical gap remains, as no direct comparisons exist between immediate and delayed resection following persistent nCR. Future studies addressing this question are essential to optimize treatment selection in this challenging population.
Core Tip: Near-complete clinical response after neoadjuvant therapy for rectal cancer is a biologically heterogeneous entity comprising distinct favorable and unfavorable subgroups. Optimal management requires individualized assessment of response trajectory rather than observation duration alone to guide organ-preservation decisions.
