How would you treat an MMR-proficient T2 N0 low-rectal cancer (measuring 2 cm extending 4-6 cm from the anal verge) in a patient who wishes to preserve his sphincter?   

Thanks for the question. I think a multidisciplinary approach is key here. First, I would make sure there is an MRI rectal performed confirming the stage of cancer and also clarify whether the patient would like to have organ preservation approach (not only the sphincter but also the rectum itself)....

Chemo RT plus trans anal resection. I’m pretty sure we have published UF data on the topic.

OPERA trial is relevant here, focused on T2-3N0-1 rectal cancers: Gerard et al., PMID 36801007.If you can find a regional Rad Onc to do rectal brachytherapy, that would maximize chances of organ preservation, but even with EBRT boost, organ preservation at 3-years is 68%, better than OPRA, understan...