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GASTROINTESTINAL CANCER

Rectal cancer — not a waiting game?

Nature Reviews Clinical Oncology volume 16, page 209 (2019)Cite this article

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Rectal cancer surgery, even by gold standard total mesorectal resection (TME), is invasive and carries a risk of complications and morbidities. With the adoption of neoadjuvant chemoradiotherapy, a watchful waiting (WW) approach has been proposed for patients with a clinical complete response (cCR) in order to delay or entirely avoid surgery. The initial results with this strategy have been promising, but new data from a retrospective study from the Memorial Sloan Kettering Cancer Center (New York, USA) raise concerns.

This case-series involved 113 patients with a cCR to neoadjuvant therapy who were subsequently managed through WW. Twenty-two of these patients had local regrowths, all of which were detected through routine surveillance (72% within 1 year of cCR), with 20 patients (91%) having pelvic disease control after salvage surgery. Notably, however, patients with local relapse had a markedly higher risk of distant metastasis (36% vs 1%; P < 0.001). Moreover, no pelvic recurrences occurred in a control group comprising 136 patients who underwent TME and had a confirmed pathological complete response to neoadjuvant therapy, and only 5 (4%) of these patients developed metastases.

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  1. Nature Reviews Clinical Oncology http://www.nature.com/nrclinonc

    David Killock

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  1. David Killock
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Correspondence to David Killock.

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Killock, D. Rectal cancer — not a waiting game?. Nat Rev Clin Oncol 16, 209 (2019). https://doi.org/10.1038/s41571-019-0174-8

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