講演情報
[INTS2-3]Oncologic Outcomes of the Watch-and-Wait Strategy for Locally Advanced Rectal Cancer: Experience from a Tertiary Care University Hospital in Thailand
*Khamin Kunkrachang1, Aitsariya Mongkhonsupphawan1, Woramin Riansuwan1 (1. Colorectal surgery Unit , Division of General Surgery ,Department of Surgery, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand)
Background: Neoadjuvant therapy for locally advanced rectal cancer can yield a clinical complete response (cCR), enabling a "watch-and-wait" (W&W) strategy that avoids surgery to preserve organ function and quality of life. However, most W&W outcomes are reported from Western countries, with limited data from Asia, particularly Thailand. We conducted this study to evaluate the oncologic outcomes of the W&W approach in Thai patients.
Methods:This retrospective study analyzed patients with rectal cancer managed via a W&W strategy at the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand, between 2011 and 2025. We evaluated the oncologic outcomes of the W&W strategy, including local regrowth, distant metastasis, and salvage surgery rates.
Results: Between 2011 and 2025, 67 rectal cancer patients who received neoadjuvant treatment and achieved a final cCR underwent the W&W protocol. Among them, 48 (71.6%) achieved early cCR, while 19 (28.4%) with a near-cCR eventually achieved late cCR. Over a median follow-up of 16.1 months (IQR: 7.4–34.0), local regrowth occurred in 9 patients (13.4%). Distant metastasis occurred in 6 patients (8.9%), 5 of whom presented with isolated lung metastases. Most local regrowth cases underwent successful salvage surgery with no mortality; however, nearly two-thirds required a permanent ostomy.
Conclusion: The W&W strategy is feasible for rectal cancer patients achieving cCR after neoadjuvant treatment, yielding acceptable oncologic outcomes. Most cases of local regrowth are amenable to successful salvage surgery. Nevertheless, a longer follow-up period and a larger cohort are necessary to further validate these findings and reduce potential bias.
Methods:This retrospective study analyzed patients with rectal cancer managed via a W&W strategy at the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand, between 2011 and 2025. We evaluated the oncologic outcomes of the W&W strategy, including local regrowth, distant metastasis, and salvage surgery rates.
Results: Between 2011 and 2025, 67 rectal cancer patients who received neoadjuvant treatment and achieved a final cCR underwent the W&W protocol. Among them, 48 (71.6%) achieved early cCR, while 19 (28.4%) with a near-cCR eventually achieved late cCR. Over a median follow-up of 16.1 months (IQR: 7.4–34.0), local regrowth occurred in 9 patients (13.4%). Distant metastasis occurred in 6 patients (8.9%), 5 of whom presented with isolated lung metastases. Most local regrowth cases underwent successful salvage surgery with no mortality; however, nearly two-thirds required a permanent ostomy.
Conclusion: The W&W strategy is feasible for rectal cancer patients achieving cCR after neoadjuvant treatment, yielding acceptable oncologic outcomes. Most cases of local regrowth are amenable to successful salvage surgery. Nevertheless, a longer follow-up period and a larger cohort are necessary to further validate these findings and reduce potential bias.