AB053. SOH25_AB_272. Watch and wait surveillance following complete clinical response to neoadjuvant treatment of rectal cancer
General Surgery I

AB053. SOH25_AB_272. Watch and wait surveillance following complete clinical response to neoadjuvant treatment of rectal cancer

Eimear Kyle1, Maeve O’Neill1, Niall O’Sullivan1, Hugo Temperley1, Brian Mehigan1, David Gallagher1, Dara Kavanagh1, John Larkin1, Charles Gillham1, Alison Corr1, Niall Sheehy1, Grainne O’Kane1,2, Paul McCormick1, Michael Kelly1,2

1Department of Surgery, St. James’ Hospital, Dublin, Ireland; 2Trinity St. James’ Cancer Institute, St. James’ Hospital, Dublin, Ireland

Background: Complete clinical response (cCR) of rectal cancer to neoadjuvant chemoradiotherapy (CRT) or total neoadjuvant therapy (TNT) may permit organ preservation with “watch and wait” (W&W) surveillance. This strategy avoids the sequelae of pelvic resectional surgery, while conferring comparable survival.

Methods: Oncologic and survival outcomes were collated from a prospectively maintained database for patients undergoing W&W surveillance.

Results: From 2016–2023, 74 patients were enrolled on W&W. Forty-six patients had a tumour in the lower third of rectum, 19 in middle third and 9 in upper third. For 28 patients (37.8%), surgical resection would require non-restorative approach with permanent stoma. Thirty-nine patients received TNT, 30 traditional long course CRT, 3 short course CRT with systemic chemotherapy and 2 chemotherapy only due to previous pelvic radiotherapy. Median follow-up was 40 months [interquartile range (IQR), 25–66 months]. Fourteen patients (18.9%) had local regrowth at median 11 months (IQR, 5–17 months) from cCR. Five patients (6.7%) developed metastases at median 8 months (IQR, 3–12 months).

Conclusions: W&W permits organ preservation for appropriately selected patients following cCR. Close endoscopic and radiological surveillance facilitates early detection of local recurrence, allowing for curative salvage surgery. Patient counselling is essential for individualised management whenever cCR is achieved.

Keywords: Complete clinical response (cCR); neoadjuvant therapy; organ preservation; rectal cancer; watch and wait

Acknowledgments

None.

Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-25-ab053
Cite this abstract as: Kyle E, O’Neill M, O’Sullivan N, Temperley H, Mehigan B, Gallagher D, Kavanagh D, Larkin J, Gillham C, Corr A, Sheehy N, O’Kane G, McCormick P, Kelly M. AB053. SOH25_AB_272. Watch and wait surveillance following complete clinical response to neoadjuvant treatment of rectal cancer. Mesentery Peritoneum 2025;9:AB053.

Article Options

Download Citation

Share