Watch and Wait in Rectal Cancer After a Complete Response to Chemoradiotherapy – Is It Safe and Are We Doing Enough?

Abstract

AimsTo summarise current understanding and the associated outcomes of the watch and wait approach after a clinical complete response (cCR) of rectal cancer to chemoradiotherapy. Materials and methodsA contemporary and comprehensive literature review was carried out using focused searches of the MEDLINE and Google Scholar databases. ResultsThe watch and wait approach is now an established and oncologically safe option for patients who develop a cCR. Long-term survival is equivalent to primary rectal resection and quality of life outcomes are demonstrably superior. The tumour regrowth rate of 25–33% is higher than local recurrence rates after total mesenteric excision. Therefore, intensive surveillance protocols are required to enable early salvage surgery. Salvage is feasible in more than 84% of cases, with equivalent survival outcomes to primary resection. DiscussionCurrent evidence focuses on patients with locally advanced disease, but there are superior rates of cCR and organ preservation in earlier stages of rectal cancer. A shift towards planning for cCR and maximising cCR rates is the logical next step for rectal preservation. Emerging evidence attempts to predict those who will achieve a complete response and allow more tailored management plans, and earlier cancers may represent the optimal targets.