Objective:To discuss the management of complete response to neoadjuvant chemoradiotherapy in patients with midlow rectal cancer. Methods:From 1997 to 2007,69 patients with stage 3 or 4 rectal cancer had preoperative radiotherapy by a total dose of 50 Gy (2Gy×25),concomitant with or without 5FU/leucovorinbased preoperative chemotherapy.Radical surgery lasted 4~6 weeks after radiation by the rule of TME. Results:Two out of 69 patients, who had clinical complete response and refused to receive surgery,had local relapse and distant metastasis. In the rest 67 patients who underwent surgery,pathologic studies showed pT0N0M0 in 7 patients,which resulted in a pathological complete response rate of 1015%.There were no recurrences or disease progression in their 12~38 months of postoperative followup. Conclusion:It should be cautious to make decision for patients with clinic complete response after neoadjuvant radiochemotherapy.These patients should be suggested to receive further radical surgery before much more evidence-based results had been carried out.