全直肠系膜切除术（TME）是进展期中低位直肠癌治疗的金标准。然而，由之而来的手术并发症发生及相应器官功能受损限制了该术式的应用。近年来，随着新辅助放化疗的进步以及免疫治疗的逐步应用，直肠癌新辅助治疗后病理完全缓解率不断提升。对于这部分病人是否仍需行TME产生质疑，因此，不行根治性手术的器官保留策略开始进入临床研究应用。目前有限的研究表明，无论是观察等待还是局部切除，虽然在部分病人中获得良好的长期生存并减少手术并发症发生和受损缺陷的优势，但还有临床完全缓解难以精准评估以及局部再发率过高导致长期生存下降等不足。仍需要进一步加强器官保留策略的探索研究，针对临床病例谨慎思考，以免该策略由“馅饼”变成“陷阱”。

Total mesorectal excision (TME) is the standard treatment for advanced mid- and low-rectal cancer. However, the associated surgical complications and subsequent impairment of organ function limit its application. In recent years, with advancements in neoadjuvant chemoradiotherapy and the implementation of immunotherapy, the pathological complete response (pCR) rate following neoadjuvant therapy for rectal cancer has significantly increased. This has raised questions about the necessity of performing TME in patients who achieve pCR. So as to, the clinical exploration of organ preservation strategies without radical surgery has been used in clinic. Current limited studies indicated that approaches such as watch & wait (W&W) or local excision have shown promising results in terms of long-term survival, and reduced surgical complications and functional impairment in some patients. However, challenges remain, including the difficulty in accurately assessing clinical complete response and the high rate of local recurrence, which could potentially compromise long-term survival. Further research into organ preservation strategies is needed, and careful consideration should be given to individual cases to prevent these strategies from becoming more of a “trap” than a “tart”.