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. 2022 Apr;24(4):401-410.
doi: 10.1111/codi.16034. Epub 2022 Jan 21.

Selected stage IV rectal cancer patients managed by the watch-and-wait approach after pelvic radiotherapy: a good alternative to total mesorectal excision surgery?

Petra A Custers  1   2 , Britt J P Hupkens  3 , Brechtje A Grotenhuis  1 , Koert F D Kuhlmann  1 , Stéphanie O Breukink  4 , Geerard L Beets  1   2 , Jarno Melenhorst  4 ; Dutch Watch-and-Wait Consortium (collaborators)
Collaborators, Affiliations

Selected stage IV rectal cancer patients managed by the watch-and-wait approach after pelvic radiotherapy: a good alternative to total mesorectal excision surgery?

Petra A Custers et al. Colorectal Dis. 2022 Apr.

Abstract

Aim: The aim of this study was to assess the clinical and oncological outcome of a selected group of stage IV rectal cancer patients managed by the watch-and-wait approach following a (near-)complete response of the primary rectal tumour after radiotherapy.

Method: Patients registered in the Dutch watch-and-wait registry since 2004 were selected when diagnosed with synchronous stage IV rectal cancer. Data on patient characteristics, treatment details, follow-up and survival were collected. The 2-year local regrowth rate, organ-preservation rate, colostomy-free rate, metastatic progression-free rate and 2- and 5-year overall survival were analysed.

Results: After a median follow-up period of 35 months, local regrowth was observed in 17 patients (40.5%). Nine patients underwent subsequent total mesorectal excision, resulting in a permanent colostomy in four patients. The 2-year local regrowth rate was 39.9%, the 2-year organ-preservation rate was 77.1%, the 2-year colostomy-free rate was 88.1%, and the 2-year metastatic progression-free rate was 46.7%. The 2- and 5-year overall survival rates were 92.0% and 67.5%.

Conclusion: The watch-and-wait approach can be considered as an alternative to total mesorectal excision in a selected group of stage IV rectal cancer patients with a (near-)complete response following pelvic radiotherapy. Despite a relatively high regrowth rate, total mesorectal excision and a permanent colostomy can be avoided in the majority of these patients.

Keywords: metastatic disease; oncological outcome; organ-preservation; rectal cancer; watch-and-wait.

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Conflict of interest statement

The authors have no conflicts of interest associated with this publication, and there has been no significant financial support for this work that could have influenced the outcomes.

Figures

FIGURE 1
FIGURE 1
Treatment schedule before entering the watch‐and‐wait registry
FIGURE 2
FIGURE 2
Local regrowth rate (A), metastatic progression‐free rate (B) and overall survival (C)
FIGURE 3
FIGURE 3
Follow‐up after entering the watch‐and‐wait registry (TME, total mesorectal excision)
FIGURE 4
FIGURE 4
Organ‐preservation rate (A) and colostomy‐free rate (B)
See this image and copyright information in PMC

Comment in

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