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Review
. 2023 Apr 14;12(8):2873.
doi: 10.3390/jcm12082873.

Watch and Wait Approach for Rectal Cancer

Carlos Cerdan-Santacruz  1   2 , Guilherme Pagin São Julião  3   4   5 , Bruna Borba Vailati  3   4   5 , Leonardo Corbi  3   4   5 , Angelita Habr-Gama  3   4   5 , Rodrigo Oliva Perez  3   4   5
Affiliations
Review

Watch and Wait Approach for Rectal Cancer

Carlos Cerdan-Santacruz et al. J Clin Med. .

Abstract

The administration of neoadjuvant chemoradiotherapy (nCRT) followed by total mesorrectal excision (TME) and selective use of adjuvant chemotherapy can still be considered the standard of care in locally advanced rectal cancer (LARC). However, avoiding sequelae of TME and entering a narrow follow-up program of watch and wait (W&W), in select cases that achieve a comparable clinical complete response (cCR) to nCRT, is now very attractive to both patients and clinicians. Many advances based on well-designed studies and long-term data coming from big multicenter cohorts have drawn some important conclusions and warnings regarding this strategy. In order to safely implement W&W, it is important consider proper selection of cases, best treatment options, surveillance strategy and the attitudes towards near complete responses or even tumor regrowth. The present review offers a comprehensive overview of W&W strategy from its origins to the most current literature, from a practical point of view focused on daily clinical practice, without losing sight of the most important future prospects in this area.

Keywords: clinical complete response; immunotherapy; local recurrence; local tumor regrowth; near-complete response; organ preservation; rectal cancer; total neoadjuvant therapy; watch and wait.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Algorithm for decision management based on risk factors for local recurrence and primary objective to achieve a cCR. ARR: anorectal ring; MRF: mesorectal fascia; mr: magnetic resonance; EMVI: extramural venous invasion; TNT: total neoadjuvant therapy; cCR: clinical complete response; TME: total mesorectal excision. While patients may undergo neoadjuvant therapy for different reasons, decision to W&W is based on the achievement of a cCR. Patients not achieving a cCR are usually recommended for surgical resection (most frequently TME).
Figure 2
Figure 2
Endoscopic view of a baseline tumor (A) and post-treatment findings consistent with a cCR using direct view (B), retroflexive view (C) and narrow-band imaging (D). Throughout images (B–D), one can appreciate the presence of a white scar and significant telangiectasia (arrows). There are no ulcers or stenosis of the rectum.
Figure 3
Figure 3
Radiological assessment using MR showing the baseline tumor (A—arrows) and an area of low-signal intensity areas consistent with a complete response in T2-weighted images (B—arrows).
Figure 4
Figure 4
Endoscopic view of a local regrowth following the achievement of a cCR.
See this image and copyright information in PMC

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