Organ preserving watch-and-wait strategy in the treatment of rectal cancer

Abstract

Watch-and-wait (WW) strategy offers an alternative to radical resection with total mesorectal excision (TME) in selected patients with distal rectal adenocarcinoma after achieving complete clinical response (cCR) to neoadjuvant therapy. This approach is based on intensive follow-up, where a multidisciplinary team, especially the surgeon, is confronted with a demanding follow-up regimen including repeated anorectoscopies, per rectum examinations and magnetic resonance imaging. The prediction of pathological complete response in cCR is particularly problematic. The risk of recur­rence (regrowth) in cCR is a key factor, which occurs in 26–36% of patients, especially during the first 3 years of follow-up, and increases the risk of metastasis. Early salvage R0 resection is indicated when regrowth is detected and is feasible in more than 90% of cases. WW offers comparable oncologic outcomes in compliant patients and better functional outcomes compared to TME in patients with pCR.

doi: 10.48095/ccrvch2025114