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Light and shadow of watch-and-wait strategy in rectal cancer: oncological result, clinical outcomes, and cost-effectiveness analysis

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International Journal of Colorectal Disease Aims and scope Submit manuscript



The watch-and-wait (WW) strategy is a potential option for patients with rectal cancer who obtain a complete clinic response after neoadjuvant therapy. The aim of this study is to analyze the long-term oncological outcomes and perform a cost-effectiveness analysis in patients undergoing this strategy for rectal cancer.

Material and methods

The data of patients treated with the WW strategy were prospectively collected from January 2015 to January 2020. A control group was created, matched 1:1 from a pool of 480 patients undergoing total mesorectal excision. An independent company carried out the financial analysis. Clinical and oncological outcomes were analyzed in both groups. Outcome parameters included surgical and follow-up costs, quality-adjusted life years (QALYs), and the incremental cost per QALY gained or the incremental cost-effectiveness ratio (ICER).


Forty patients were included in the WW group, with 40 patients in the surgical group. During a median follow-up period of 36 months, metastasis-free survival (MFS) and overall survival (OS) were similar in the two groups. In the WW group, nine (22%) local regrowths were detected in the first 2 years. The permanent stoma rate was slightly higher after salvage surgery in the WW group compared to the surgical group (48.5% vs 20%, p < 0.01). The cost-effectiveness analysis was slightly better for the WW group, especially for low rectal cancer compared to medium–high rectal cancer (ICER =  − 108,642.1 vs ICER =  − 42,423).


The WW strategy in locally advanced rectal cancer offers similar oncological outcomes with respect to the surgical group and excellent results in quality of life and cost outcomes, especially for low rectal cancer. Nonetheless, the complex surgical field during salvage surgery can lead to a high permanent stoma rate; therefore, the careful selection of patients is mandatory.

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Data availability

Because of the sensitive nature of the data collected for this study, requests to access the dataset from qualified researchers trained in human subject confidentiality protocols may be sent to Valentina Ferri at The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


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This study was supported by the Foundation for Development and Investigation in Surgical Oncology of Madrid and by the International Investigation Department in General and Digestive Surgery of the Catholic University of Murcia.

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Authors and Affiliations



Emilio Vicente and Yolanda Quijano proposed the study. Valentina Ferri and Riccardo Caruso performed research and wrote the first draft. Hipolito Duran, Eduardo Diaz, and Isabel Fabra collected and analyzed the data. All authors contributed to the design and interpretation of the study and to further drafts. Valentina Ferri is the guarantor.

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Correspondence to Valentina Ferri.

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This study was approved by the Ethics Committee of the Sanchinarro Hospital, San Pablo University, Madrid, Spain.

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No benefits in any form have been received or will be received from a commercial party.

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Ferri, V., Vicente, E., Quijano, Y. et al. Light and shadow of watch-and-wait strategy in rectal cancer: oncological result, clinical outcomes, and cost-effectiveness analysis. Int J Colorectal Dis 38, 277 (2023).

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