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Some authors have suggested that these patients do not need to undergo surgery and can be managed with careful follow\u2010up, with surgery only used in the event of clinical failure. Widespread adoption of this regimen is limited by the accuracy of methods to confirm a pathological complete response (p<jats:styled-content style=\"fixed-case\">CR<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A systematic search of PubMed, Medline and Cochrane databases was conducted to identify clinical, histological and radiological features in those patients with rectal cancer who achieved a p<jats:styled-content style=\"fixed-case\">CR<\/jats:styled-content> following chemoradiotherapy. Searches were conducted with the following keywords and <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>e<jats:styled-content style=\"fixed-case\">SH<\/jats:styled-content> search terms: \u2018rectal neoplasm\u2019, \u2018response\u2019, \u2018neoadjuvant\u2019, \u2018preoperative chemoradiation\u2019 and \u2018tumour response\u2019. After review of title and abstracts, 89 articles addressing the assessment of p<jats:styled-content style=\"fixed-case\">CR<\/jats:styled-content> were identified.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Histology and clinical assessment are the most effective methods of assessment of p<jats:styled-content style=\"fixed-case\">CR<\/jats:styled-content>, with histology considered the gold standard. Clinical assessment is limited to low rectal tumours and is open to significant inter\u2010rater variability, while histological examination requires a surgical specimen. Diffusion\u2010weighted <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> and <jats:sup>18<\/jats:sup>F\u2010fluorodeoxyglucose positron emission tomography\/<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> demonstrate the greatest potential for the assessment of p<jats:styled-content style=\"fixed-case\">CR<\/jats:styled-content>, but both modalities have limited accuracy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Determination of a p<jats:styled-content style=\"fixed-case\">CR<\/jats:styled-content> is crucial if a nonoperative approach is to be undertaken proactively. Various methods are available, but currently they lack sufficient sensitivity and specificity to define management. 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