• Sofieke J D Temmink, Koen C M J Peeters, Renu R Bahadoer, KranenbargElma Meershoek-KleinEMDepartment of Surgery, Leiden University Medical Centre, Leiden, the Netherlands., Annet G H Roodvoets, Jarno Melenhorst, BurgerJacobus W AJWADepartment of Surgery, Catharina Ziekenhuis, Eindhoven, the Netherlands., Albert Wolthuis, Andrew G Renehan, Nuno L Figueiredo, Oriol Pares, Anna Martling, Rodrigo O Perez, Geerard L Beets, van de VeldeCornelis J HCJHDepartment of Surgery, Leiden University Medical Centre, Leiden, the Netherlands., Per J Nilsson, and International Watch & Wait Database (IWWD) Consortium.
• Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
• Br J Surg. 2023 May 16; 110 (6): 676684676-684.

BackgroundIn rectal cancer, watch and wait for patients with a cCR after neoadjuvant treatment has an established evidence base. However, there is a lack of consensus on the definition and management of a near-cCR. This study aimed to compare outcomes in patients who achieved a cCR at first reassessment versus later reassessment.MethodsThis registry study included patients from the International Watch & Wait Database. Patients were categorized as having a cCR at first reassessment or at later reassessment (that is near-cCR at first reassessment) based on MRI and endoscopy. Organ preservation, distant metastasis-free survival, and overall survival rates were calculated. Subgroup analyses were done for near-cCR groups based on the response evaluation according to modality.ResultsA total of 1010 patients were identified. At first reassessment, 608 patients had a cCR; 402 had a cCR at later reassessment. Median follow-up was 2.6 years for patients with a cCR at first reassessment and 2.9 years for those with a cCR at later reassessment. The 2-year organ preservation rate was 77.8 (95 per cent c.i. 74.2 to 81.5) and 79.3 (75.1 to 83.7) per cent respectively (P = 0.499). Similarly, no differences were found between groups in distant metastasis-free survival or overall survival rate. Subgroup analyses showed a higher organ preservation rate in the group with a near-cCR categorized exclusively by MRI.ConclusionOncological outcomes for patients with a cCR at later reassessment are no worse than those of patients with a cCR at first reassessment.© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

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