**4. Conclusion**

Organ-preservation strategies to treat ERC are effective and, when carefully considered, have acceptable outcomes comparable to TME surgery. Technological advances have improved accessibility of MIS and interest in non-operative treatment continues to grow. However, there are important gaps in the evidence on surgical versus non-surgical treatment. Also, there is a lack of understanding of how patients weigh and prioritise their perceptions of potential benefits over that of morbidity and the risk of local recurrence. Decisions on ERCs other than a 'good' T1 (that is an SM1, R0, no lympho-vascular invasion) treated by local excision remain a challenge, specifically when balancing the likelihood of over- versus under-treatment. It is therefore imperative on well-informed specialists of the MDT to offer the best estimates on outcomes towards shared decision-making with patients.

Overall, the prospects for ERC treatment are very promising. As the current trend to organ-preservation continues, along with current and future research, so too will our understanding of therapeutic strategies improve towards standardising management.
