Combined Transanal and Laparoscopic Approach for Full-Thickness Local Excision of Locally Advanced Rectal Cancer Following Near-Complete Response after Chemotherapy

Improving neoadjuvant therapies for locally advanced rectal cancer (LARC) has increased the rates of clinical complete response (cCR). The watch-and-wait approach has emerged as a viable strategy for patients with cCR, avoiding the potential morbidity of radical surgery. However, the management of near-complete response (nCR) remains controversial. We present a case of a 46-year-old male with cT4, node indeterminate, mid-to-upper rectal adenocarcinoma. The patient declined radical resection and radiotherapy. Clinical nCR of the tumor was confirmed on imaging and endoscopy following six cycles of oxaliplatin and capecitabine (chemotherapy only). He underwent full-thickness local excision of the remnant lesion using a combined transanal and laparoscopic approach. Histopathological examination revealed high-grade dysplasia without residual malignancy. There has been no evidence of tumor recurrence at nine months post-surgery. This case demonstrates the safety and feasibility of minimally invasive local excision in selected patients with nCR following neoadjuvant therapy for LARC.