For patients with early stage rectal cancer who achieve complete response following chemoradiotherapy, next steps for treatment are not always clear. While some believe patients should undergo total mesorectal excision, others prefer a more conservative strategy of active surveillance, or “watch-and-wait.” Unfortunately, there are limited data on the long-term impact of watch-and-wait on patient outcomes. In a study published in Annals of Surgery, the authors retrospectively evaluated the impact of watch-and-wait as a treatment strategy in 385 patients achieving near-complete or complete clinical response following neoadjuvant treatment.
At a median follow-up of 28 months, 89 patients (23%) undergoing active surveillance developed a suspected local regrowth. The median time between end of neoadjuvant treatment and development of regrowth was 9 months. A total of 94% of these patients underwent surgical excision of the local regrowth, with 69% opting for total mesorectal excision. Among patients undergoing surgical treatment, the 2-year local recurrence-free rate was 97.8%, and 91.8% were free of distant metastases. The 2-year overall survival (OS) was 98.4%.
The investigators concluded that watch-and-wait is an effective strategy for patients with early stage rectal cancer who achieve complete remission following neoadjuvant chemoradiotherapy. The major benefit of this approach is avoiding the high morbidity and decreased quality-of-life associated with total mesorectal excision while still allowing for early detection of disease recurrence. The authors stressed that a watch-and-wait approach should only be used in coordination with careful follow-up and regular screening in order to detect patients developing recurrence at an early stage.
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Ann Surg. 2020 Feb 7. [Epub ahead of print.]