Watch and Wait Approach for Rectal Cancer

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Standard treatment for locally advanced rectal cancer (LARC) involves neoadjuvant chemoradiotherapy (nCRT), total mesorectal excision (TME), and adjuvant chemotherapy.
• The watch and wait (W&W) approach is gaining traction as an organ-preserving alternative for LARC patients achieving clinical complete response (cCR) after nCRT.
• W&W aims to avoid the sequelae of TME while maintaining oncological safety.

Purpose of the Study:

• To provide a comprehensive overview of the W&W strategy for LARC.
• To discuss practical considerations for implementing W&W in daily clinical practice.
• To highlight future prospects and necessary adaptations for the W&W approach.

Main Methods:

• Review of current literature and long-term data from multicenter cohorts on the W&W strategy.
• Analysis of case selection criteria, optimal treatment protocols, and surveillance strategies.
• Evaluation of management approaches for near-complete responses and tumor regrowth.

Main Results:

• Advances in research provide important conclusions and warnings regarding the W&W strategy.
• Proper patient selection, tailored treatment, vigilant surveillance, and defined responses to near-complete responses are essential for safe W&W implementation.
• The W&W strategy is attractive to both patients and clinicians due to its organ-preserving nature.

Conclusions:

• The W&W strategy is a viable and attractive option for select LARC patients who achieve cCR post-nCRT.
• Successful implementation of W&W requires meticulous attention to patient selection, treatment protocols, and ongoing surveillance.
• Continued research and data collection are vital for refining the W&W approach and ensuring optimal patient outcomes.