Current Status of “Watch-and-Wait” Rectal Cancer Treatment in Asia-Pacific Countries

• Published in: Annals of coloproctology Vol. 36; no. 2; pp. 70 - 77
• Main Authors: Huh, Jung Wook, Maeda, Kotaro, Liu, Zheng, Wang, Xishan, Roslani, April Camilla, Lee, Woo Yong
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Coloproctology 01.04.2020; 대한대장항문학회
• Subjects: Current Practice in Asia-Pacific Region; neoadjuvant chemoradiotherapy; rectal neoplasms; watch and wait; 일반외과학; Watch and wait; Rectal neoplasms; Neoadjuvant chemoradiotherapy
• ISSN: 2287-9714; 2287-9722
• DOI: 10.3393/ac.2020.01.19

Purpose: Current acceptance of the watch-and-wait (W&W) approach by surgeons in Asia-Pacific countries is unknown. An international survey was performed to determine status of the W&W approach on behalf of the Asia-Pacific Federation of Coloproctology (APFCP).Methods: Surgeons in the APFCP completed an Institutional Review Board-approved anonymous e-survey and/or printed letters (for China) containing 19 questions regarding nonsurgical close observation in patients who achieved clinical complete response (cCR) to neoadjuvant chemoradiotherapy (nCRT).Results: Of the 417 responses, 80.8% (n = 337) supported the W&W approach and 65.5% (n = 273) treated patients who achieved cCR after nCRT. Importantly, 78% of participants (n = 326) preferred a selective W&W approach in patients with old age and medical comorbidities who achieved cCR. In regard to restaging methods after nCRT, the majority of respondents based their decision to use W&W on a combination of magnetic resonance imaging results (94.5%, n = 394) with other test results. For interval between nCRT completion and tumor response assessment, most participants used 8 weeks (n = 154, 36.9%), followed by 6 weeks (n = 127, 30.5%) and 4 weeks (n = 102, 24.5%). In response to the question of how often responders followed-up after W&W, the predominant period was every 3 months (209 participants, 50.1%) followed by every 2 months (75 participants, 18.0%). If local regrowth was found during follow-up, most participants (79.9%, n = 333) recommended radical surgery as an initial management.Conclusion: The W&W approach is supported by 80% of Asia-Pacific surgeons and is practiced at 65%, although heterogeneous hospital or society protocols are also observed. These results inform oncologists of future clinical study participation.