Abstract
Introduction: The colorectal carcinoma is the most common gastrointestinal neoplasm worldwide and in Bulgaria. Often the choice of surgical treatment is difficult, and organ-preserving surgery is not feasible. In borderline situations when choosing a surgical approach is difficult, a neoadjuvant chemoradiotherapy may downstage the disease and provide better results and more surgical options. If the treatment response is partial or complete, the possibility of carrying out sphincter-sparing surgery is increased. The aim of the study is to present a clinical case of a patient with rectal carcinoma, submitted to multimodal treatment.
Case report: The presented patient is a 65-year old female with alarming symptoms and diagnosed rectal adenocarcinoma. The patient underwent preoperative neoadjuvant treatment. After a full course of treatment, the patient was restaged and reported a complete clinical response to therapy. After recommended period, she underwent an anterior resection of the rectum. This case is an example of the potential possibilities of a multidisciplinary team in surgical oncology.
Conclusions: There are certain criteria, regarding the waiting approach in rectal carcinoma, and it subjected to a set of indications in case of a complete response to the treatment. The current case is an excellent example of performing a sphincter-spearing surgery, which may lead to higher quality of life for the target patient group. The ESMO guidelines for neoadjuvant treatment of rectal adenocarcinoma are applicable in Bulgaria.

Key words: rectal carcinoma, neoadjuvant treatment, waiting approach, chemoradiotherapy