Locally advanced rectal cancer: what patients and practitioners should know about non-operative management

Résumé fourni par la source

For decades, the standard of care for locally advanced rectal cancer (LARC) has consisted of rectal surgery combined with chemoradiotherapy, saving many lives but often impairing long-term quality of life. Recently, emerging evidence shows that, for up to 40% of patients, surgery may no longer be needed. Non-operative management (NOM), also known as watch-and-wait, allows patients whose tumours completely regress after treatment (whether immunotherapy or total neoadjuvant therapy) to be safely monitored without mandatory surgery; avoiding time and cost of major surgery and preserving both the rectum and quality of life. NOM is part of a broader trend in oncology: from a one-size-fits-all strategy to treatment de-escalation for those who do not need maximal intervention. In mismatch repair proficient/microsatellite stable (pMMR/MSS) LARC, this de-escalation has been paradoxically achieved by initial intensification using total neoadjuvant therapy to later omit surgery. This Viewpoint aims to outline for a broad medical audience, including non-specialist physicians and individuals in care, how recent advances are reshaping rectal cancer treatment. By discussing NOM as an opportunity to move beyond a purely surgical paradigm, we hope to increase awareness of NOM options to inform evidence-based decision-making, reduce treatment-related morbidity, and promote patient-centred models of care and shared decision-making.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.