Watch and wait after neoadjuvant treatment in rectal cancer: Comparison of outcomes in patients with and without a complete response at first reassessment in the International Watch & Wait Database (IWWD)

Sofieke J. D. Temmink, Koen C. M. J. Peeters, Renu R. Bahadoer, Elma Meershoek-Klein Kranenbarg, Annet G. H. Roodvoets, Jarno Melenhorst, Jacobus W. A. Burger, Albert Wolthuis, Andrew G. Renehan, Nuno L. Figueiredo, Oriol Pares, Anna Martling, Rodrigo O. Perez, Geerard L. Beets, Cornelis J. H. van de Velde, Per J. Nilsson, M. Aghili, A. Keshvari, M. K. Nouritaromlou, M. AhlbergS. Kordnejad, A. Aleinikov, A. Dulskas, O. Asoǧlu, H. Tokmak, R. G. Barroca, A. F. Caiado, I. A. L. Rosa, S. O. Breukink, M. F. Coraglio, S. Iseas, B. Creaven, D. C. Winter, A. Zaborowski, C. Cunningham, E. Gregory, P. A. Custers, B. M. Geubels, L. Debrun, A. D'Hoore, G. Dimofte, K. Fechner, K. Matzel, L. Fernandez, A. I. Herrando, P. Vieira, W. B. Gaertner, R. D. Madoff, J. P. Gerard, F. Jacquinot, R. Schiappa, S. Gollins, M. Gonzalez, C. A. Vaccaro, A. Habr-Gama, Julião G. P. São, F. A. Holman, R. Hompes, W. Lameris, S. H. J. Ketelaers, H. J. T. Rutten, K. Leitner, C. Mazzarisi, L. Malcomson, S. T. O'Dwyer, M. Saunders, A. Maroli, P. Mitchell, S. Murad-Regadas, A. Pairola, Salazar I. Pedraza, Loria F. Sanchez, A. J. Pennings, A. Spinelli, Myint A. Sun

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Abstract

Background: In 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. Methods: This 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. Results: A 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. Conclusion: Oncological outcomes for patients with a cCR at later reassessment are no worse than those of patients with a cCR at first reassessment.
Original languageEnglish
Pages (from-to)676-684
Number of pages9
JournalBritish Journal of Surgery
Volume110
Issue number6
DOIs
Publication statusPublished - 1 Jun 2023

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