The management of locally advanced rectal cancer has changed drastically in the last few decades due to improved surgical techniques, development of multimodal treatment approaches and the introduction of a watch and wait WW strategy. For patients with a complete response to neoadjuvant treatment, WW offers an opportunity to avoid the morbidity associated with total mesorectal excision in favor of organ preservation.
Despite growing interest in WW, prospective data on the safety and efficacy of nonoperative management are limited. Challenges remain in optimizing multimodal treatment regimens to maximize tumor regression and in improving the accuracy of patient selection for WW. This review summarizes the history of treatment for rectal cancer and the development of a WW strategy. It also provides an overview of clinical considerations for patients interested in nonoperative management, including restaging strategies, WW selection criteria, surveillance protocols and long-term oncologic outcomes.
Colorectal cancer is one of the most common malignancies in the United States, with a third of cases located in the rectum 1.
The management of rectal cancer has changed drastically in the last few decades due to improved surgical techniques and the development of multimodal treatment approaches. Until recently, the standard of care for locally advanced rectal cancer LARC included neoadjuvant chemoradiation and total mesorectal excision TME followed by adjuvant chemotherapy. This excellent prognosis raised the question of whether patients with a pCR gained any oncologic benefit from surgical resection.
In , Habr-Gama et al. The safety and efficacy of this approach relied on accurately identifying a complete response using a clinical assessment in place of histologic confirmation of a pCR. WW offered the promise of organ preservation and improved quality of life by eliminating the long-term functional deficits associated with TME.
