International Journal of Colorectal Disease

, Volume 31, Issue 2, pp 413–419 | Cite as

Rectal cancer with complete clinical response after neoadjuvant chemoradiotherapy, surgery, or “watch and wait”

  • Chien-Liang Lai
  • Mei-Ju Lai
  • Chang-Chieh Wu
  • Shu-Wen Jao
  • Cheng-Wen HsiaoEmail author
Original Article



The purpose of this study was to compare the outcomes of patients treated with chemoradiotherapy with a complete clinical response followed by either a “watch and wait” strategy or a total mesorectal excision.


This was an observational retrospective study from a single institute. Patients with locally advanced rectal cancer following chemoradiotherapy with a complete clinical response from January 1, 2007 to December 31, 2014 were included.


The study population consisted of 18 patients who opted for a “watch and wait” policy and 26 patients who underwent radical surgery after achieving a complete clinical response. Patients had no documented treatment complications under the watch and wait policy, while 13 patients who underwent radical surgery experienced significant morbidity. There were two local recurrences in the watch and wait group; both were treated with salvage resection and had no associated mortality. In the radical surgery group, 1 patient showed an incomplete pathologic response (ypT0N1), and the remaining 25 patients showed complete pathologic responses; 1 had a distant recurrence, which was managed non-operatively, and 2 patients died of unrelated causes. The 5-year overall survival rate and median disease-free survival time were 100 % and 69.78 months in the watch and wait group and 92.30 % and 89.04 months in the radical surgery group.


A watch and wait policy avoids the morbidity associated with radical surgery and preserves oncologic outcomes in our retrospective study from a single institute. It could be considered a therapeutic option in patients with locally advanced rectal cancer following chemoradiotherapy with a complete clinical response.


Chemoradiotherapy Rectal cancer Complete clinical response Watch and wait 



We are grateful to the Cancer Registry Group of Tri-Service General Hospital from offering its data pool for the analysis.

Authors’ contributions

Chien-Liang Lai, MD, Chang-Chieh Wu, MD, and Shu-Wen Jao, MD, reviewed the data and prepared the initial manuscript draft, and Mei-Ju Lai, MD, participated in the initial workup of the case described herein, and reviewed the data. Mei-Ju Lai, MD, assisted Chien-Liang Lai, MD, in preparing the final version of the manuscript. Cheng-Wen Hsiao, MD, has been involved in revising it critically for important intellectual content and have given final approval of the version to be published; Chien-Liang Lai, MD, and Cheng-Wen Hsiao, MD, agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors state that there are no financial or personal relationships with other people or organizations that could inappropriately influence this work.


  1. 1.
    Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart A (2010) Revised tumor and node categorization for rectal cancer based on surveillance, epidemiology, and end results and rectal pooled analysis outcomes. J Clin Oncol 28(2):256–263PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Pomerri F, Maretto I, Pucciarelli S et al (2009) Prediction of rectal lymph node metastasis by pelvic computed tomography measurement. Eur J Surg Oncol 35(2):168–173CrossRefPubMedGoogle Scholar
  3. 3.
    Solanki AA, Chang DT, Liauw SL (2013) Future directions in combined modality therapy for rectal cancer: reevaluating the role of total mesorectal excision after chemoradiotherapy. Onco Target Ther 6:1097–1110Google Scholar
  4. 4.
    Hartley JE, Mehigan BJ, Qureshi AE, Duthie GS, Lee PW, Monson JR (2001) Total mesorectal excision: assessment of the laparoscopic approach. Dis Colon Rectum 44(3):315–321CrossRefPubMedGoogle Scholar
  5. 5.
    Lujan J, Valero G, Hernandez Q, Sanchez A, Frutos MD, Parrilla P (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96(9):982–989CrossRefPubMedGoogle Scholar
  6. 6.
    Asoglu O, Kunduz E, Rahmi Serin K et al (2014) Standardized laparoscopic sphincter-preserving total mesorectal excision for rectal cancer: long-term oncologic outcome in 217 unselected consecutive patients. Surg Laparosc Endosc Percutan Tech 24(2):145–152CrossRefPubMedGoogle Scholar
  7. 7.
    Kasparek MS, Hassan I, Cima RR, Larson DR, Gullerud RE, Wolff BG (2012) Long-term quality of life and sexual and urinary function after abdominoperineal resection for distal rectal cancer. Dis Colon Rectum 55(2):147–154CrossRefPubMedGoogle Scholar
  8. 8.
    De Nardi P, Carvello M (2013) How reliable is current imaging in restaging rectal cancer after neoadjuvant therapy? World J Gastroenterol 19(36):5964–5972PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Habr-Gama A, Gama-Rodrigues J, São Julião GP et al (2014) Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation: impact of salvage therapy on local disease control. Int J Radiat Oncol Biol Phys 88(4):822–828CrossRefPubMedGoogle Scholar
  10. 10.
    Dedemadi G, Wexner SD (2012) Complete response after neoadjuvant therapy in rectal cancer: to operate or not to operate? Dig Dis 30(Suppl 2):109–117CrossRefPubMedGoogle Scholar
  11. 11.
    Mark D, Joon DL, Chao M et al (2010) The use of PET in assessing tumor response after neoadjuvant chemoradiation for rectal cancer. Radiother Oncol 97(2):205–211CrossRefGoogle Scholar
  12. 12.
    Pucciarelli S, Capirci C, Emanuele U et al (2005) Relationship between pathologic T-stage and nodal metastasis after preoperative chemoradiotherapy for locally advanced rectal cancer. Ann Surg Oncol 12:111–116CrossRefPubMedGoogle Scholar
  13. 13.
    Pucciarelli S, Friso ML, Toppan P et al (2000) Preoperative combined radiotherapy and chemotherapy for middle and lower rectal cancer: preliminary results. Ann Surg Oncol 7:38–44CrossRefPubMedGoogle Scholar
  14. 14.
    Habr-Gama A, Perez RO, Nadalin W et al (2004) Operative versus non-operative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 240:711–718PubMedCentralPubMedGoogle Scholar
  15. 15.
    Perez RO, São Julião GP, Habr-Gama A et al (2009) The role of carcinoembriogenic antigen in predicting response and survival to neoadjuvant chemotherapy for distal rectal cancer. Dis Colon Rectum 52:1137–1143CrossRefPubMedGoogle Scholar
  16. 16.
    Smith JD, Ruby JA, Goodman KA et al (2012) Nonoperative management of rectal cancer with complete clinical response after neoadjuvant therapy. Ann Surg 256(6):965–972CrossRefPubMedGoogle Scholar
  17. 17.
    Park JS, Jang YJ, Choi GS et al (2014) Accuracy of preoperative MRI in predicting pathology stage in rectal cancers: node-for-node matched histopathology validation of MRI features. Dis Colon Rectum 57(1):32–38CrossRefPubMedGoogle Scholar
  18. 18.
    Maas M, Beets-Tan RG, Lambregts DM et al (2011) Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol 29:4633–4640CrossRefPubMedGoogle Scholar
  19. 19.
    Martellucci J, Scheiterle M, Lorenzi B et al (2012) Accuracy of transrectal ultrasound after preoperative radiochemotherapy compared to computed tomography and magnetic resonance in locally advanced rectal cancer. Int J Colorectal Dis 27(7):967–973CrossRefPubMedGoogle Scholar
  20. 20.
    Pomerri F, Pucciarelli S, Maretto I et al (2011) Prospective assessment of imaging after preoperative chemoradiotherapy for rectal cancer. Surgery 149:56–64CrossRefPubMedGoogle Scholar
  21. 21.
    Hiotis SP, Weber SM, Cohen AM et al (2002) Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer: an analysis of 488 patients. J Am Coll Surg 194(2):131–135, discussion 135–6CrossRefPubMedGoogle Scholar
  22. 22.
    Park YA, Lee KY, Kim NK et al (2006) Prognostic effect of perioperative change of serum carcinoembryonic antigen level: a useful tool for detection of systemic recurrence in rectal cancer. Ann Surg Oncol 13:645–650CrossRefPubMedGoogle Scholar
  23. 23.
    Smith RK, Fry RD, Mahmoud NN, Paulson EC (2015) Surveillance after neoadjuvant therapy in advanced rectal cancer with complete clinical response can have comparable outcomes to total mesorectal excision. Int J Colorectal Dis 30(6):769–774. doi: 10.1007/s00384-015-2165-2 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Chien-Liang Lai
    • 1
  • Mei-Ju Lai
    • 2
  • Chang-Chieh Wu
    • 1
  • Shu-Wen Jao
    • 1
  • Cheng-Wen Hsiao
    • 1
    Email author
  1. 1.Division of Colon and Rectal Surgery, Department of SurgeryTri-Service General Hospital, National Defense Medical CenterTaipeiRepublic of China
  2. 2.Division of Clinical Pathology, Department of PathologyTri-Service General Hospital, National Defense Medical CenterTaipeiRepublic of China

Personalised recommendations