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Short-term outcomes from the 'Watch and Wait' (WoW) study: prospective cohort study.
Daniel Rydbeck1,2, Najia Azhar3,4, Lennart Blomqvist5,6
1Department of Surgery, SSORG-Scandinavian Surgical Outcomes Research Group, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.
BJS Open
|January 24, 2025
Summary
The Swedish national watch and wait study found that early rectal cancer regrowth rates were similar to previous research. Most patients with regrowth could undergo successful salvage surgery with curative intent.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Non-operative management (watch and wait) for rectal cancer is increasingly used globally despite limited level 1 evidence on long-term oncological safety.
- A pan-national prospective study in Sweden was initiated in 2017 to evaluate the implementation of watch and wait strategies.
Purpose of the Study:
- To report short-term outcomes of a national watch and wait study for rectal cancer.
- To assess local regrowth rate, distant metastasis rate, and outcomes after salvage surgery at 6 months follow-up.
Main Methods:
- Inclusion of patients with biopsy-proven rectal cancer achieving clinical complete response after neoadjuvant therapy.
- Opportunistic watch-and-wait approach was employed, with inclusion and follow-up managed at participating centers.
- Primary outcome: 3-year disease-free survival; Secondary outcomes reported: 6-month local regrowth, distant metastasis, and salvage surgery outcomes.
Main Results:
- 211 patients with clinical complete response were included between January 2017 and February 2023.
- Sixteen percent (33/211) of patients experienced suspicious regrowth within 6 months; 94% (32/33) underwent salvage surgery with curative intent.
- Distant metastases were observed in 1.4% (3/211) of patients within 6 months.
Conclusions:
- Short-term regrowth rates in this Swedish national watch and wait study align with existing literature.
- The majority of patients experiencing early regrowth were successfully treated with salvage surgery, maintaining curative intent.