Organ preservation in rectal cancer: Clinical basis of the watch-and-wait strategy

Locally advanced rectal cancer has traditionally been treated with neoadjuvant chemoradiotherapy, followed by total mesorectal excision (TME)-a technique that is effective but associated with high morbidity and functional impairment. The identification of patients with a clinical complete response (cCR) after treatment has driven the adoption of the "Watch-and-Wait" (W&W) strategy, aimed at avoiding surgery without compromising oncologic safety. Current evidence, drawn from international series, multicentre records, and clinical trials, supports the view that W&W offers overall survival and disease-free survival rates comparable to those of radical surgery, with clear advantages in organ preservation and quality of life. However, this strategy requires careful patient selection, standardised re-evaluation protocols, and intensive follow-up in specialised centres. In summary, W&W has become a valid and safe alternative to surgical treatment in selected patients with rectal cancer following neoadjuvant therapy.