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Half of rectal cancer patients given all their chemotherapy and radiotherapy first can keep their rectum. Nobody has ever randomised that against having the operation, so the trade-off between avoiding a stoma and the risk of the cancer regrowing is still guesswork.
Habr-Gama watched 71 of 265 patients whose rectal cancers vanished after chemoradiotherapy and reported ten-year overall survival of 97.7 percent across the series; OPRA made the strategy plannable, with three-year survival free of total mesorectal excision of 53 percent after consolidation chemotherapy and disease-free survival matching the 75 percent historical rate. In mismatch repair-deficient disease the question has been answered emphatically: every one of 49 rectal cancers treated with six months of dostarlimab had a clinical complete response, 82 of 103 patients across both Cercek cohorts avoided surgery, and two-year recurrence-free survival was 92 percent.
For the mismatch repair-proficient 90 percent, the evidence remains single-arm or historically controlled. OPRA's comparison is against historical data; regrowth continues beyond three years; and the assumption that salvage surgery after regrowth costs nothing rests on subgroup comparisons within the same non-randomised cohort. Meanwhile the thing patients actually weigh, long-term bowel, urinary and sexual function after watch and wait against after total mesorectal excision, has never been a primary endpoint.
For mismatch repair-deficient rectal cancer, six months of a single antibody now replaces chemotherapy, radiotherapy and an operation, and the same appears to be true for early-stage mismatch repair-deficient cancers of other organs.
Organ preservation became a plan rather than an accident: consolidation chemotherapy after chemoradiotherapy gives the best chance of keeping the rectum, and salvage surgery after regrowth does not appear to cost survival.
The first total neoadjuvant therapy trial to change practice in high-risk rectal cancer, and the schedule that makes organ preservation possible by giving the tumour months rather than weeks to respond.
The origin of organ preservation in rectal cancer. Twenty years later OPRA made it a planned strategy and the dostarlimab series made it the expected outcome in mismatch repair-deficient disease.
Shares PRODIGE 23, Short-course radiotherapy followed by chemotherapy before total mesorectal excision versus preoperative chemoradiotherapy in locally advanced rectal cancer (RAPIDO), Total neoadjuvant therapy (TNT, rectal cancer), Total mesorectal excision (TME) and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Surgery and radiotherapy cure most, get least, MRI and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work, Surgery and radiotherapy cure most, get least, Robotic & minimally invasive surgery and the tag colorectal-evidence.
Shares Short-course radiotherapy followed by chemotherapy before total mesorectal excision versus preoperative chemoradiotherapy in locally advanced rectal cancer (RAPIDO), Total mesorectal excision (TME), Radiotherapy, MRI and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.
Shares Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work, Surgery and radiotherapy cure most, get least, MRI, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.
Shares CAPOX (capecitabine, oxaliplatin), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, FOLFOX (5-FU, leucovorin, oxaliplatin), Toxicity and quality of life are undervalued and the tag colorectal-evidence.