Research status and progress of watch and wait strategy after neoadjuvant therapy for rectal cancer

doi:10.3877/cma.j.issn.1674-3946.2022.05.030

Abstract

Abstract:

Preoperative neoadjuvant chemoradiotherapy（NCRT）combined with total mesenterectomy is the standard treatment mode for locally advanced rectal cancer（LARC）. NCRT has a good effect on reducing tumor stage，and 15% to 20% of LARC patients can obtain clinical complete remission（CCR）after NCRT. In view of the potential postoperative complications and decreased postoperative quality of life，some scholars proposed a watch and wait strategy（W&W）for patients with cCR after neoadjuvant therapy：no surgery，regular review，so as to preserve organ function and improve the quality of life without affecting the survival rate. However，the following problems emerged in the implementation of W&W：（1）Which neoadjuvant therapy can improve the cCR rate as much as possible？（2）How long is the best time to define cCR after neoadjuvant therapy？（3）The correct assessment of cCR and its relationship with pathological complete remission（pCR）？（4）Can the long-term prognosis of patients receiving W&W achieve the same effect of radical operation？（5）How to deal with the long-term follow-up difficulties and possible recurrence and metastasis of W&W patients？Based on this，the author made a literature review on the research status of W&W since its launch，the controversial points and research direction of cCR，so as to provide some reference for the diagnosis and treatment of clinical cCR patients.

Key words: Rectal neoplasms, Neoadjuvant therapy, Watch and wait, Clinical complete response

Lu Hao, Ye Yuan, Xiangnan Yu, Yuan Li, Yang Cao, Kaixiong Tao, Zheng Wang, Guobin Wang. Research status and progress of watch and wait strategy after neoadjuvant therapy for rectal cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(05): 584-588.

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References 49

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研究	时间	例	cCR(%)			LR(%)
Renehan^[18]	2016	259	31(12.0)			44(34)
Sanchez等^[19]	2016	68	68(100.0)			6(8.8)
武爱文等^[20]	2017	35	26(74.3)			5(14.3)
王林等^[21]	2018	-	62（-）			15(24.2)
van der valk等^[16]	2018	1009	880(87.2)			213(24.2)
Haak等^[17]	2020	304	43(14.1)			5(11.6)
研究	时间	例	OS(%)		DFS(%)		生存时间(年)
研究	时间	例	W&W	手术	W&W	手术	生存时间(年)
Renehan^[18]	2016	259	96.0	87.0	88.0	78.0	3
Sanchez等^[19]	2016	68	93.8	-	76.3	-	5
武爱文等^[20]	2017	35	92.7	-	(CSS) 100.0	-	3
王林等^[21]	2018	-	88.6	-	100.0	-	3
van der valk等^[16]	2018	1009	84.7	-	(DSS) 93.8	-	5
Haak等^[17]	2020	304	97.0	-	91.0	-	3

研究	时间	例	cCR(%)			LR(%)
Renehan^[18]	2016	259	31(12.0)			44(34)
Sanchez等^[19]	2016	68	68(100.0)			6(8.8)
武爱文等^[20]	2017	35	26(74.3)			5(14.3)
王林等^[21]	2018	-	62（-）			15(24.2)
van der valk等^[16]	2018	1009	880(87.2)			213(24.2)
Haak等^[17]	2020	304	43(14.1)			5(11.6)
研究	时间	例	OS(%)		DFS(%)		生存时间(年)
研究	时间	例	W&W	手术	W&W	手术	生存时间(年)
Renehan^[18]	2016	259	96.0	87.0	88.0	78.0	3
Sanchez等^[19]	2016	68	93.8	-	76.3	-	5
武爱文等^[20]	2017	35	92.7	-	(CSS) 100.0	-	3
王林等^[21]	2018	-	88.6	-	100.0	-	3
van der valk等^[16]	2018	1009	84.7	-	(DSS) 93.8	-	5
Haak等^[17]	2020	304	97.0	-	91.0	-	3

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