Organ preservation strategies in rectal cancer management are safe and effective.

• 26% of patients underwent organ preservation, with higher rates in early-stage cases (51% vs. 18.1%).
• Watch and wait was used for 78% of these patients, showing similar short-term outcomes to local excision.
• At 2 years, overall survival exceeded 95% across the board, with no significant differences in disease-free or local recurrence-free survival.

Surgeons should consider these options to tailor treatment based on patient response, particularly in non-metastatic cases.