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‘Watch and wait’ in rectal cancer: summary of the current evidence

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Abstract

Background

The management of rectal cancer has evolved considerably over the last few decades with increasing use of neoadjuvant chemoradiotherapy (nCRT). Complete clinical response (cCR) and even complete pathological response (pCR) have been noted in a proportion of patients who had surgery after nCRT. This raises the concern that we may have been ‘over-treating’ some of these patients and lead to an increasing interest in ‘watch and wait’ (W&W) approach for patients who had cCR to avoid the morbidity associated with rectal surgery.

Methods

A review of the literature in English pertaining to rectal cancer in the context of W&W, organ preservation and active surveillance.

Results

Evidence available to support W&W approach comes from non-randomised controlled trials (RCTs) with no current consensus on patients’ selection criteria, lack of viable predictors of both cCR and pCR and lack of universal definitions of cCR and pCR. Also, there is no agreed protocol for disease surveillance.

Conclusion

Even though there has been increasing reports on the outcomes of W&W in rectal cancer, the current evidence cannot support its routine use in clinical practice. This approach should be used in clinical trials settings or after thorough counselling with the patient on the outcomes of various treatment options.

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Authors and Affiliations

  1. Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK

    Jason On & Emad H Aly

  2. University of Aberdeen, Foresterhill, Aberdeen, Scotland, AB25 2ZN, UK

    Emad H Aly

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JO: Evidence collection and writing manuscript.

EHA: Conception, guided writing manuscript and produced final manuscript.

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Correspondence to Emad H Aly.

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On, J., Aly, E.H. ‘Watch and wait’ in rectal cancer: summary of the current evidence. Int J Colorectal Dis 33, 1159–1168 (2018). https://doi.org/10.1007/s00384-018-3116-5

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