Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2015; 7(11): 306-312
Published online Nov 27, 2015. doi: 10.4240/wjgs.v7.i11.306
Watch and wait approach to rectal cancer: A review
Marcos E Pozo, Sandy H Fang
Marcos E Pozo, Sandy H Fang, Ravitch Division, Colorectal Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, United States
Author contributions: Pozo ME and Fang SH contributed equally to this work as follows: Conception and design, acquisition of data, analysis and interpretation of data, drafting the article, critical revisions, and final approval of the version to be published.
Conflict-of-interest statement: There are no conflicting interests to report from both authors of this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Sandy H Fang, MD, Assistant Professor, Director, Ravitch Division, Colorectal Surgery, Department of Surgery, Johns Hopkins Hospital, Blalock 618, 600 North Wolfe Street, Baltimore, MD 21287, United States.
Telephone: +1-410-9557323 Fax: +1-410-6149866
Received: June 28, 2015
Peer-review started: June 29, 2015
First decision: August 16, 2015
Revised: September 15, 2015
Accepted: September 29, 2015
Article in press: September 30, 2015
Published online: November 27, 2015

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.