AbstractBackgroundMultimodal treatment is the standard of care for rectal adenocarcinoma, with a subset of patients achieving a pathologic complete response (pCR). While pCR is associated with improved overall survival (OS), long‐term data on patients with pCR is limited.MethodsThis is a single institution retrospective cohort study of all patients with clinical stages II/III rectal adenocarcinoma who underwent neoadjuvant chemoradiation therapy and operative resection (January 1, 2004–December 31, 2017). PCR was defined as no tumor identified in the rectum or associated lymph nodes by final pathology.ResultsOf 370 patients in this cohort, 50 had a pCR (13.5%). For pCR patients, 5‐year disease‐free survival (DFS) was 92%, 5‐year OS was 95%. Twenty‐six patients had surgery > 10 years before the study end date, of which 20 had an OS > 10 years (77%) with median OS 12.1 years and 95% alive to date (19/20). Of the 50 pCR patients, there was a single recurrence in the lung at 44.3 months after proctectomy which was surgically resected.ConclusionFor patients with rectal adenocarcinoma that undergo neoadjuvant chemoradiation and surgical resection, pCR is associated with excellent long‐term DFS and OS. Many patients live greater than 10 years with no evidence of disease recurrence.