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The Ongoing Development of Watch and Wait.
Mikhael Belkovsky1, Ali Alipouriani2, Arielle E Kanters2
1Department of Surgery, University of Massachusetts, Worcester, Massachusetts.
Clinics in Colon and Rectal Surgery
|June 12, 2025
Summary
The watch and wait (W&W) approach for rectal cancer, using clinical complete response (cCR) after neoadjuvant chemoradiation (nCRT), shows high survival rates. This nonoperative strategy offers reduced morbidity for selected patients without compromising outcomes.
Area of Science:
- Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Watch and wait (W&W) is an evolving nonoperative management strategy for rectal cancer.
- It relies on achieving a clinical complete response (cCR) after neoadjuvant chemoradiation (nCRT) to predict pathological complete response (pCR).
- Increasing efficacy of nCRT regimens has made W&W a feasible option for select patients.
Purpose of the Study:
- To review the historical development and efficacy of the W&W strategy for rectal cancer.
- To provide current recommendations for W&W based on recent clinical evidence.
- To assess the oncological outcomes and quality of life implications of W&W.
Main Methods:
- Literature review of historical and contemporary studies on W&W for rectal cancer.
- Analysis of clinical trial data focusing on response rates and survival outcomes.
- Evaluation of patient-reported outcomes and morbidity associated with W&W.
Main Results:
- Achieving cCR after nCRT is a reliable indicator of pCR in W&W candidates.
- Patients managed with W&W who achieve cCR demonstrate 5-year disease-free survival rates of 85-92%.
- W&W offers a potential for significantly reduced treatment-related morbidity and improved quality of life.
Conclusions:
- The watch and wait strategy is a safe and effective nonoperative option for rectal cancer patients achieving cCR post-nCRT.
- W&W can preserve quality of life and reduce surgical morbidity without negatively impacting survival.
- Continued research and standardized protocols are essential for optimizing W&W implementation.
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