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BACKGROUND:The routine application of neoadjuvant chemoradiotherapy for T3N0 rectal cancer remains controversial. The aim of this study was to use clinical, Magnetic resonance imaging, and pathological parameters to identify a subgroup of patients with low risk of local recurrence who might be precluded from neoadjuvant chemoradiotherapy. METHODS:We retrospectively reviewed a prospectively maintained database of consecutive rectal cancer patients who underwent curative resection. 166 pathologic confirmed T3N0 rectal cancer patients with tumor located 5-12 cm above the anal verge and preoperative circumferential resection margin >1 mm were included in analysis. The primary outcomes measured were 3- and 5-year local recurrence rates. RESULTS:Local recurrence was demonstrated during follow-up in 5 patients; the actuarial overall 3- and 5-year local recurrence rates were 2.5% and 3.4%, respectively. Inadequate sampling of lymph nodes (≤12) was associated with higher local recurrence (P = 0.03) in this group of patients. CONCLUSION:For upper and middle T3N0 rectal cancer with preoperative circumferential resection margin >1 mm, local recurrence rate after total mesorectal excision is low and surgery alone may be enough for this group of patients.