# Watch and wait after chemoradiotherapy for rectal cancer

Source: https://onco.cc/terms/watch-and-wait-rectal-cancer/  
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## TL;DR

In some people the rectal tumour disappears completely after chemotherapy and radiotherapy. Watch and wait means keeping the rectum and checking it closely instead of removing it, and operating only if the tumour comes back. About a quarter of regrowths happen, almost all within two years, and almost all can still be operated on.

## Summary

What it is. After chemoradiotherapy, a minority of rectal tumours leave no trace on digital examination, endoscopy (a flat white scar) or magnetic resonance imaging. Rather than proceed to total mesorectal excision, with its stoma risk and its effect on bowel, urinary and sexual function, the team can keep the rectum and watch it intensively. The finding that justifies it is the clinical complete response, which has its own glossary term.

The evidence. The International Watch and Wait Database pooled 1,009 patients from 47 institutions in 15 countries and analysed the 880 with a clinical complete response. The two-year cumulative incidence of local regrowth was 25.2 percent; 88 percent of regrowths appeared in the first two years and 97 percent were in the bowel wall, where endoscopy can find them and surgery can still remove them. Distant metastases occurred in 8 percent. Five-year overall survival was 85 percent and five-year disease-specific survival 94 percent (van der Valk 2018). The OPRA trial randomised 324 patients with stage II or III rectal cancer to induction chemotherapy then chemoradiotherapy, or chemoradiotherapy then consolidation chemotherapy, offering watch and wait to those with a complete or near-complete response. At three years, disease-free survival was 76 percent in both arms and rectum-free survival 41 and 53 percent; at a median of 5.1 years, five-year disease-free survival was 71 and 69 percent and rectum-free survival 39 and 54 percent. Of the 81 patients who had a regrowth, 94 percent occurred within two years and 99 percent within three, and disease-free survival was the same (64 percent) whether the rectum was removed after restaging or after a regrowth (Garcia-Aguilar 2022; 2024).

What the guidelines say. NICE NG151 (1.3.7) asks clinicians to tell people with a complete clinical and radiological response who wish to defer surgery that there is a risk of recurrence and that no prognostic factor identifies who can safely defer, to encourage entry into a clinical trial, and to make sure the outcome is recorded in a national registry. In mismatch repair-deficient rectal cancer the route to organ preservation is immunotherapy rather than chemoradiotherapy, and the parent record carries those trials.

## Fields

- Kind: Term
- Last checked: 2026-09-24
- Also known as: watch and wait rectal cancer; non-operative management of rectal cancer; deferral of surgery; organ preservation rectal cancer; watch-and-wait; watch and wait
- Tags: gi; colorectal

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Watchful_waiting
- van der Valk, Lancet 2018: long-term outcomes of clinical complete responders in the International Watch and Wait Database (880 patients): https://doi.org/10.1016/s0140-6736(18)31078-x
- Garcia-Aguilar, J Clin Oncol 2022: OPRA, organ preservation in rectal adenocarcinoma treated with total neoadjuvant therapy (324 patients): https://doi.org/10.1200/jco.22.00032
- Verheij, J Clin Oncol 2024: long-term results of the OPRA trial (median follow-up 5.1 years): https://doi.org/10.1200/jco.23.01208
- NICE NG151: colorectal cancer, recommendations (Lynch 1.1, local disease 1.3, biomarkers 1.4, metastatic disease 1.5, ongoing care and support including follow-up 1.6): https://www.nice.org.uk/guidance/ng151/chapter/Recommendations

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Mismatch-repair deficient (MSI-high) colorectal cancer](https://onco.cc/cancers/msi-high-colorectal/), [Rectal cancer](https://onco.cc/cancers/rectal-cancer/)
- technologies: [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [MRI](https://onco.cc/technologies/mri/)
- terms: [Circumferential resection margin (rectal cancer)](https://onco.cc/terms/circumferential-resection-margin/), [Clinical complete response (cCR)](https://onco.cc/terms/clinical-complete-response/), [Endoscopy (EGD, EUS, ERCP)](https://onco.cc/terms/endoscopy/), [Organ preservation (watch-and-wait, bladder-sparing, larynx preservation)](https://onco.cc/terms/organ-preservation/), [Total mesorectal excision (TME)](https://onco.cc/terms/total-mesorectal-excision/), [Total neoadjuvant therapy (TNT, rectal cancer)](https://onco.cc/terms/total-neoadjuvant-therapy/)

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