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Organ preservation has emerged as a therapeutic objective in low rectal cancer management, particularly for patients achieving complete or near-complete response following neoadjuvant chemoradiotherapy. While radical surgery remains the standard recommendation in current guidelines, watch-and-wait (WW) strategies are increasingly used. We report 28 cases managed with endoscopic full-thickness resection of the scar and adjacent tissue as an alternative, all with R0 resection. Histology showed ypT0, ypT1 and ypT2 in 17, 5 and 6 cases. Among ypT2 cases, one received salvage surgery, while five received adjuvant radiochemotherapy. All patients remained recurrence-free over a median 25-month follow-up. Major low anterior resection syndrome occurred in one patient.