Selected rectal cancer patients can safely skip neoadjuvant therapy and proceed directly to total mesorectal excision.

• Among 94 patients, 100% had local recurrence-free survival at 3 years; 97% at 5 years.
• R0 resection achieved in 99%, leading to substantial overall survival rates of 97% at 3 years and 95% at 5 years.

This evidence supports refining patient selection for surgery, minimizing unnecessary preoperative treatment while maintaining excellent outcomes.

• 87% distant metastasis-free survival at 3 years; 81% at 5 years underscores the effectiveness of this approach.