Published online Sep 27, 2026. doi: 10.4240/wjgs.121131
Revised: May 23, 2026
Accepted: July 7, 2026
Published online: September 27, 2026
Processing time: 145 Days and 22.6 Hours
For patients with clinical complete response (cCR) after neoadjuvant therapy for rectal cancer (RC), traditional radical surgery involves significant trauma, and the long-term oncological safety of the wait-and-see strategy for organ preservation needs further verification.
To assess and compare long-term oncological outcomes between the watch-and-wait approach and radical surgery in patients with locally advanced RC achieving cCR following neoadjuvant chemoradiotherapy.
This retrospective cohort study included 100 RC patients treated at our hospital from October 2020 to October 2022 who achieved cCR after neoadjuvant therapy. Patients were allocated to the watch-and-wait group (n = 45) or the radical surgery group (n = 45) based on patient preference and multidisciplinary team recommendations. Three-year disease-free survival (DFS), overall survival (OS), recurrence patterns, and quality of life were evaluated and compared between groups.
Kaplan-Meier analysis showed 3-year DFS rates of 86.67% (39/45) in the watch-and-wait group and 91.11% (41/45) in the radical surgery group, with no statistically significant difference (Log-rank χ2 = 0.512, P = 0.474). Three-year OS rates were 95.56% (43/45) and 97.78% (44/45), respectively, with no significant difference (Log-rank χ2 = 0.347, P = 0.556). Overall recurrence rates were comparable between the two groups (P > 0.05). At 24 months post-enrollment, the watch-and-wait group showed significantly higher scores for role, emotional, and social functioning, and global health status (P < 0.05) and lower scores for fatigue, pain, insomnia, diarrhea, and urinary dysfunction (P < 0.05) compared with the radical surgery group. Cox regression identified baseline cN2 stage as an independent predictor of 3-year DFS (hazard ratio = 4.128, 95% confidence interval: 1.265-13.468, P = 0.019), whereas treatment strategy did not significantly influence DFS.
In patients with locally advanced RC achieving cCR after neoadjuvant chemoradiotherapy, the watch-and-wait strategy provides comparable 3-year DFS, OS, and recurrence rates to radical surgery while conferring superior medium- and long-term quality of life. These findings support watch-and-wait as a safe and feasible organ-preserving approach.
Core Tip: This study compared long-term oncological outcomes between the watch-and-wait strategy and radical surgery in 100 rectal cancer patients with clinical complete response after neoadjuvant therapy. Results showed comparable 3-year disease-free survival, overall survival, and recurrence rates, while watch-and-wait conferred better quality of life, supporting watch-and-wait as a safe organ-preserving option.