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Watch and Wait in Patients with Clinical Complete Response After Neoadjuvant Therapy with Rectal Cancer: Is it Safe?
1Department of Surgery, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, USA.
Advances in Surgery
|August 5, 2026
Summary
Total neoadjuvant therapy offers significant tumor eradication for rectal cancer. Watch-and-wait management enables organ preservation in half of patients, but requires careful surveillance to avoid recurrence.
Area of Science:
- Oncology
- Surgical Gastroenterology
- Clinical Medicine
Background:
- Rectal cancer treatment has evolved significantly.
- Total neoadjuvant therapy (TNT) has improved outcomes, achieving complete tumor eradication in nearly 40% of patients.
- Nonoperative management, including watch-and-wait (W&W), is emerging as an alternative to surgery.
Purpose of the Study:
- To evaluate the efficacy and safety of watch-and-wait strategies in locally advanced rectal cancer.
- To assess the rate of organ preservation and recurrence in patients managed nonoperatively.
- To highlight the importance of protocolized surveillance for watch-and-wait success.
Main Methods:
- Review of treatment outcomes for locally advanced rectal cancer.
- Analysis of patients undergoing watch-and-wait management.
- Assessment of local regrowth and distant recurrence rates.
- Evaluation of surveillance protocols in nonoperative management.
Main Results:
- Approximately 50% of watch-and-wait patients achieve long-term organ preservation.
- The remaining 50% experience either local regrowth or distant recurrence.
- Local regrowth necessitates prompt surgical intervention.
- Distant recurrence requires appropriate management strategies.
Conclusions:
- Watch-and-wait is a viable option for select rectal cancer patients.
- Successful implementation requires a structured protocol and rigorous surveillance.
- Careful patient selection and adherence to surveillance are crucial for safety and efficacy.
- This approach offers the potential to avoid surgery for a subset of patients.
