The Landmark Series: Organ Preservation in Rectal Cancer-The Watch and Wait Strategy

Area of Science:

• Oncology
• Colorectal Surgery
• Gastroenterology

Background:

• Rectal cancer treatment has advanced with improved staging, surgical techniques like total mesorectal excision (TME), and multimodality therapy.
• Despite progress, TME surgery is associated with significant complications and functional issues for rectal cancer patients.
• Organ-preserving strategies such as transanal local excision (TAE) and Watch and Wait (WW) are gaining traction to minimize surgical morbidity.

Purpose of the Study:

• To provide an updated overview of the Watch and Wait (WW) approach for rectal cancer.
• To cover the fundamental aspects of patient selection for the WW strategy.
• To present current outcomes data for patients managed with WW.

Main Methods:

• This is a narrative review of existing literature on the Watch and Wait (WW) approach for rectal cancer.
• The review synthesizes information on patient selection criteria and treatment outcomes.
• Focus is on providing practical information for clinicians.

Main Results:

• The Watch and Wait (WW) approach is presented as an organ-preserving alternative to TME for selected rectal cancer patients.
• Key factors for successful patient selection and management within the WW protocol are discussed.
• Outcomes data regarding local control and survival are summarized, highlighting the oncological safety of WW in appropriate cases.

Conclusions:

• The Watch and Wait (WW) strategy represents a viable organ-preserving option for rectal cancer, aiming to reduce surgical complications.
• Careful patient selection is crucial for optimizing outcomes in the WW approach.
• Further research and clinical experience will continue to refine the role of WW in rectal cancer management.