In our last episode, we explored Total Neoadjuvant Therapy, or TNT, which has revolutionized the management of high-risk locally advanced rectal cancer by increasing pathologic complete response, or pCR, rates and improving distant control. These impressive pCR rates have opened the door to one of the most exciting and debated topics in rectal cancer: avoiding major surgery through "Watch and Wait," or Non-Operative Management. Today, we dive deep into this organ-preserving approach, defining who is a candidate and what surveillance entails. We'll examine key trials like OPRA and data from the International Watch and Wait Database. Finally, we'll shift to a truly groundbreaking development: the highly effective management of mismatch repair deficient, or dMMR, rectal cancer with immunotherapy, which is dramatically changing the treatment landscape for these patients.

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