• 40% of patients with a complete clinical response (CCR) endoscopically had residual disease on MRI.
• After a mean follow-up of 4.8 years, 30% had disease regrowth, with no significant difference in rates based on MRI results (33% vs. 27.8%).

Surgeons should be cautious in relying solely on MRI for treatment decisions following total neoadjuvant therapy, as endoscopic CCR does not guarantee a lack of disease.

• 67% of patients with positive MRI findings did not experience regrowth after 4 years.