Watch and wait approach to rectal cancer: A review

Abstract

In 2014, there were an estimated 136800 new cases of colorectal cancer, making it the most common gastrointestinal malignancy. It is the second leading cause of cancer death in both men and women in the United States and over one-third of newly diagnosed patients have stage III (node-positive) disease. For stage II and III colorectal cancer patients, the mainstay of curative therapy is neoadjuvant therapy, followed by radical surgical resection of the rectum. However, the consequences of a proctectomy, either by low anterior resection or abdominoperineal resection, can lead to very extensive comorbidities, such as the need for a permanent colostomy, fecal incontinence, sexual and urinary dysfunction, and even mortality. Recently, trends of complete regression of the rectal cancer after neoadjuvant chemoradiation therapy have been confirmed by clinical and radiographic evaluation-this is known as complete clinical response (cCR). The “watch and wait” approach was first proposed by Dr. Angelita Habr-Gama in Brazil in 2009. Those patients with cCR are followed with close surveillance physical examinations, endoscopy, and imaging. Here, we review management of rectal cancer, the development of the “watch and wait” approach and its outcomes.

Keywords: Rectal cancer; Watch and wait approach; Neoadjuvant chemotherapy rectal cancer; Nonoperative management rectal cancer

Core tip: Standard treatment for stage II and IIIrectal cancer includes neoadjuvant chemoradiation followed by radical surgical resection. Recent studies have demonstrated that a select population of patients will achieve a pathological complete response with the absence of residual cancer present after surgical resection. Preliminary attempts to identify those rectal cancer patients with a clinical complete response to neoadjuvant therapy, through various diagnostic modalities, may prevent future patients from having to undergo a very morbid operation.