Non-surgical “Watch and Wait” Approach to Rectal Cancer

Purpose of Review: The standard of care for locally advanced rectal cancer is preoperative chemoradiation (CRT) followed by total mesorectal excision (TME). Patients who achieve a pathologic complete response (pCR) to CRT have favorable oncologic outcomes. Given the significant morbidity and long-term effects on quality of life associated with radical resection, the role of surgery in the subgroup of patients with a clinical complete response (cCR), of whom a significant proportion may have a pCR, is under debate. Recent Findings: An emerging tailored approach to treatment is a “watch and wait” strategy in patients who have a cCR after CRT with the goal of organ preservation. However, concordance between a cCR and pCR is not highly reliable, and improved multimodality prediction algorithms are needed to better predict which patients have achieved a pCR and can therefore safely undergo a “watch and wait” approach. Summary: We review the current data on non-operative management of rectal cancer and ongoing controversies associated with this approach.