Alternative treatment to surgery for rectal cancer

The traditional concept of rectal cancer management has changed significantly over the last few years. Although surgical resection remains central the treatment of distal rectal cancer by proctectomy and total mesorectal excision (TME), there has been increased interest in organ preservation strategies. Neoadjuvant chemoradiation (nCRT) may result in significant tumor regression and complete pathological response may be observed in up to 42% of patients. In order to avoid the morbidity, mortality and functional consequences of major surgery, selected patients with clinical and radiological evidence of significant tumor regression after nCRT have been managed non-operatively with strict follow-up (Watch & Wait Strategy—WW) with acceptable outcomes and minimal functional consequences. In addition, close surveillance may allow early detection of local recurrences and salvage alternatives with no oncological compromise.