AB053. SOH25_AB_272. Watch and wait surveillance following complete clinical response to neoadjuvant treatment of rectal cancer

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Background: Complete clinical response (cCR) of rectal cancer to neoadjuvant chemoradiotherapy (CRT) or total neoadjuvant therapy (TNT) may permit organ preservation with “watch and wait” (W&W) surveillance. This strategy avoids the sequelae of pelvic resectional surgery, while conferring comparable survival. Methods: Oncologic and survival outcomes were collated from a prospectively maintained database for patients undergoing W&W surveillance. Results: From 2016–2023, 74 patients were enrolled on W&W. Forty-six patients had a tumour in the lower third of rectum, 19 in middle third and 9 in upper third. For 28 patients (37.8%), surgical resection would require non-restorative approach with permanent stoma. Thirty-nine patients received TNT, 30 traditional long course CRT, 3 short course CRT with systemic chemotherapy and 2 chemotherapy only due to previous pelvic radiotherapy. Median follow-up was 40 months [interquartile range (IQR), 25–66 months]. Fourteen patients (18.9%) had local regrowth at median 11 months (IQR, 5–17 months) from cCR. Five patients (6.7%) developed metastases at median 8 months (IQR, 3–12 months). Conclusions: W&W permits organ preservation for appropriately selected patients following cCR. Close endoscopic and radiological surveillance facilitates early detection of local recurrence, allowing for curative salvage surgery. Patient counselling is essential for individualised management whenever cCR is achieved.

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