Purpose <p>Our objective was to evaluate the utilization and clinical impact of CONNECT-LR, an asynchronous teleconsultation system for locally recurrent rectal cancer (LRRC), focusing on resectability assessment and clinical trial referral.</p> Methods <p>In this multicenter, prospective observational study, we included all cases submitted to CONNECT-LR between August 2019 and March 2025, as well as referring physicians and consultants. Referring physicians securely uploaded anonymized clinical and imaging data through a dedicated platform, and consultants responded within 1 week. Data were collected in predefined categories, including consultation purposes and recommendations, physician and institutional characteristics, and user and consultant surveys assessing satisfaction and clinical course. The analysis comprised descriptive statistics.</p> Results <p>Overall, 77 consultations were conducted. Most referring physicians were gastrointestinal surgeons (97.4%). The primary purpose of consultation was resectability assessment in 55 cases (71.4%). Of the 34 cases initially judged as unresectable or with uncertain resectability by referring physicians, 24 (70.6%) were reclassified as resectable by consultants, and surgical resection was performed in 15 of these 34 cases (44.1%), predominantly following referral to consultants’ institutions. Six patients were enrolled in a randomized controlled trial for resectable LRRC. User satisfaction was high: 93.3% of referring physicians and 76.1% of consultants reported being satisfied or somewhat satisfied.</p> Conclusions <p>CONNECT-LR effectively provides expert judgment, often altering resectability assessments and increasing access to curative-intent surgery for patients with LRRC, offering a potential pathway to clinical trial participation. As a feasible, secure, and scalable model, this teleconsultation platform may help reduce regional disparities and expand access to subspecialty care for LRRC.</p>