Is watch and wait a safe and effective way to treat rectal cancer in older patients?

• Published in: European journal of surgical oncology Vol. 46; no. 3; pp. 358 - 362
• Main Authors: Haak, Hester E., Maas, Monique, Lambregts, Doenja M.J., Beets-Tan, Regina G.H., Beets, Geerard L., Melenhorst, Jarno, Sande, Marit E. van der, Westreenen, Henderik L. van, Talsma, A.K. (Koen), Breukink, Stephanie O., Zimmerman, David D.E., Hilling, Denise E., Wilt, Johannes H.W. de, Peeters, Koen C.M.J., Graaf, Eelco J.R. de, Tuynman, Jurriaan B., Sonneveld, Dirk J.A., Komen, Niels, Pronk, Apollo, Intven, Martijn, Schreurs, W.H. (Hermien), Hoff, Christiaan
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.03.2020
• Subjects: Chemoradiation; Functional outcomes; Older patients; Oncological outcomes; Rectal cancer; Watch-and-wait approach; Older patients; Watch-and-wait approach; Oncological outcomes; Rectal cancer; Chemoradiation; Functional outcomes
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2020.01.005

The aim was assess the oncological and functional outcome of the watch-and-wait (W&W) approach in older patients with a clinical (near)complete response after neoadjuvant treatment for rectal cancer. Patients were included in a W&W-approach (2004–2019) when digital rectal examination, endoscopy and MRI showed a (near)clinical complete response. Patients underwent endoscopy and MRI every 3 months during the first year, and 6-monthly thereafter. Patients aged ≥75 and ≥ 2 years of follow-up (FU) were selected. Oncological outcomes were assessed with Kaplan-Meier curves. Functional outcome was assessed with colostomy-free rate, Vaizey incontinence score, low anterior resection syndrome-score and International Prostate Syndrome Score. 43/304 (14%) of patients in a W&W-approach met the inclusion criteria. Median FU was 37 (24–109) months. 5/43(12%) developed a local regrowth. All were treated surgically, with one patient experiencing a pelvic failure. Distant metastases occurred in 3/43 patients and 4 patients died, 3 of whom not related to rectal cancer. The 3-year local regrowth-free rate was 88%, 3-year non-regrowth disease-free survival 91%, overall survival 97% and 3-year colostomy-free rate 93%. Overall, the bowel- and urinary dysfunction scores at 3, 12 and 24 months indicated good continence, no or minor LARS and moderate urinary problems. W&W for older patients with a clinical (near) complete response appears to be a safe alternative to a total mesorectal excision (TME), with a very high pelvic control rate, and few rectal cancer related deaths. Most patients can avoid major surgery and a definitive colostomy, and have a reasonable anorectal and urinary function.