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

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

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.

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Correspondence to Cheng-Wen Hsiao.

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

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Lai, CL., Lai, MJ., Wu, CC. et al. Rectal cancer with complete clinical response after neoadjuvant chemoradiotherapy, surgery, or “watch and wait”. Int J Colorectal Dis 31, 413–419 (2016). https://doi.org/10.1007/s00384-015-2460-y

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  • DOI: https://doi.org/10.1007/s00384-015-2460-y

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