For selected patients with stage II or III rectal cancer, a direct-to-surgery approach led to favorable 2-year oncologic outcomes.

• Local recurrence rate was just 1% among patients undergoing low anterior resection.
• Disease-free survival was 85%, and overall survival reached 99%.

Surprisingly, only 8% of patients required post-operative radiation therapy.

• Preoperative MRI overstaged 51% of patients who were ultimately confirmed as stage I.