Current treatment of rectal cancer: The watch-and-wait method. Are we there yet?

Surgery remains the standard treatment of rectal carcinoma, with the use of neoadjuvant chemotherapy and radiation for locally advanced rectal carcinoma significantly decreasing local recurrence rates, as well as providing tumor downstaging. In those patients who exhibit complete pathological response, the question of the benefit of surgical resection and the utility of a ‘wait-and-see’ approach has been raised. However, the variability in determining a true pathological complete response, as well as the inability to accurately stage the nodes, argues against a non-operative approach. Many small series have attempted to evaluate a non-operative approach in patients considered pathological complete responders; however, these series are not well designed. In addition, adequate follow-up is limited. Thus, the inability to adequately select true pathological responders and the risk of leaving nodal disease behind outweighs the benefit of a non-operative approach. The use of an observational approach is not justified until further well-designed prospective trials are performed.