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Introduction: The colorectal carcinoma is the most common gastrointestinal neoplasm worldwide and in Bulgaria. The choice of surgical treatment is often difficult, and organ-preserving surgery is not feasible. In borderline situations, when choosing a surgical approach is difficult, the neoadjuvant chemoradiotherapy may downsize the tumor and provide better results and more surgical options. If the treatment response is partial or complete, the possibility of 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 disturbing symptoms and diagnosed rectal adeno- carcinoma. The patient underwent preoperative neoadjuvant treatment. After a full course of treatment, the tumor was resized and was reported an almost complete clinical response to the therapy. After the recommended period had ended, 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 “Watch and wait” approach in rectal carcinoma, and it subjected to a set of indications in the case of a complete or near complete response to the treatment. The current case is not the brightest example of applying this approach, but still is a case of performing a sphincter-spearing surgery, which may lead to higher quality of life of the target patient group. The ESMO guidelines for the neoadjuvant treatment of rectal adenocarcinoma are applicable in Bulgaria.