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

摘要

? 2022 The Royal College of RadiologistsAims: To 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 methods: A contemporary and comprehensive literature review was carried out using focused searches of the MEDLINE and Google Scholar databases. Results: The 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. Discussion: Current 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.