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Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastroenterology

Background:

  • Preoperative chemoradiotherapy (CRT) followed by total mesorectal excision is standard for locally advanced rectal cancer.
  • Pathologic complete response (pCR) after CRT yields favorable oncologic outcomes.
  • Surgery's morbidity and quality-of-life impact prompt reevaluation for pCR patients.

Purpose of the Study:

  • To review current data on nonoperative management for rectal cancer.
  • To discuss controversies surrounding the
  • watch-and-wait
  • approach.
  • To highlight the need for improved prediction of pCR after CRT.

Main Methods:

  • Review of current literature on nonoperative management after CRT for rectal cancer.
  • Analysis of data regarding clinical complete response (cCR) versus pCR.
  • Discussion of imaging and clinical modalities for predicting pCR.

Main Results:

  • A clinical complete response (cCR) does not always equate to a pathologic complete response (pCR).
  • The
  • watch-and-wait
  • strategy is being explored for organ preservation in select patients.
  • Significant morbidity is associated with radical rectal resection.

Conclusions:

  • Nonoperative management, or
  • watch-and-wait
  • , is a developing strategy for rectal cancer patients with cCR.
  • Accurate prediction of pCR is essential to safely omit surgery.
  • Further research into predictive modalities is needed to refine patient selection.