Can Rectal Cancer Patients with Complete Response to Neoadjuvant Chemoradiotherapy Avoid Surgery?

Purpose: Rectal cancer is one of the most common malignancies worldwide. Neoadjuvant chemoradiotherapy (nCRT) is now the standard treatment for locally advanced rectal cancer. The aims of this study are to assess the feasibility of the “Watch and Wait” (WW) pathway for patients who achieved complete clinical response compared with surgery in patients treated with neoadjuvant therapy for rectal cancer. In addition, we evaluated the accuracy of magnetic resonance imaging (MRI) in assessing the residual cancer after neoadjuvant therapy. Methods: We conducted a retrospective review of patients who had neoadjuvant therapy for rectal cancer with MRI restaging. All patients were followed-up for a minimum of 2 years to assess the efficacy of (WW) pathway. MRI results were compared with either excision results or 3-month follow-up to assess MRI accuracy. Results: We included 41 patients. Average age was 69 ± 10 years. Eleven females and 30 males were included. The 2-year survival and disease-free survival (DFS) rates were 73% and 61.5% for the surgical group and 53.3% and 46.7% for the (WW) group, respectively. MRI sensitivity for detecting residual tumor was 57.69% with an accuracy rate of 70.73%, while when combining with other tests, the sensitivity increased to 80.77% with an accuracy rate of 85.37%. Conclusion: “Watch and Wait” approach is a safe and acceptable approach guided by regular monitoring and careful selection of the patients. There was no significant difference in 2-year survival and DFS between patients who had surgery and patients who opted for (WW) pathway.