| Abstract: |
BACKGROUND: The use of a watch-and-wait management strategy after a complete clinical response to neoadjuvant therapy for rectal cancer is increasing. However, insights into implementation, treatments, and outcomes on a national level in the United States are limited. OBJECTIVE: To investigate and report on watchand- wait management practices and outcomes in the United States. DESIGN: Retrospective study. SETTING: Multicenter. PATIENTS: Patients with stage II or III rectal cancer who underwent intentional watch-and-wait management between January 2015 and August 2022. MAIN OUTCOME MEASURES: Patient and tumor characteristics, neoadjuvant treatment and response, local cancer regrowth and metastasis, salvage surgery, overall survival, and disease-specific survival. RESULTS: Among 545 patients from 33 centers, follow-up was 21 months (range, 9-37). Total neoadjuvant therapy or other types of neoadjuvant therapy were used in 395 (72%) and 150 (28%) patients, respectively. The estimated 3-year local regrowth rate was 23.8% (95% CI, 19.1%-29.4%). Patients with local regrowth had higher distant metastases incidence (14.2% vs 3.5%, p < 0.001). Salvage surgery was performed in 74 of 84 patients (88%) with local regrowth and included rectal resection in 66 patients (89%) and local excision in 8 (11%). Of 64 salvage resections with known pathology results, 58 (91%) were margin-negative. Overall, 3-year overall survival was 94.8% (95% CI, 90.5%-97.2%) and 3-year disease-specific survival was 96.2% (95% CI, 91.8%-98.2%). Patients with and without local regrowth exhibited 3-year overall survival of 83.6% (95% CI, 68.4%- 91.9%) and 97.7% (95% CI, 93.3%-99.2%), respectively. LIMITATIONS: Retrospective study. CONCLUSIONS: This multicenter study indicates that the watch-and-wait approach for locally advanced rectal cancer is feasible with acceptable outcomes across a variety of geographical regions and practice settings in the United States. Local regrowth and distant metastasis rates were within published norms and salvage surgery proved effective. See Video Abstract. © The ASCRS 2024. |
