Which patients would you offer a watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer?

I would never offer watch and wait as an alternative, even in the patients with an apparent clinical complete response, and I would attempt to dissuade any patient from pursuing this approach. Even after apparent clinical complete response, we frequently see pathologic evidence of residual disease. ...

Given the available data I do not offer it as a "standard of care" except in patients with medically inoperable disease. Patients who are surgical candidates with cT3 disease who achieve a cCR and have a negative biopsy I mention it as a "possibility." However, I emphasize that it may compromise sph...

I am a pretty conservative guy and I would share the view that randomized prospective data on this issue would be ideal, and I suspect that a trial or two are in progress as we discuss this topic. However, from a statistical point of view, propensity score matching is pretty good insofar as observat...

I've been surprised by the lack of correlation between physical exam and path response. You can have the nastiest looking residual tumor that is completely path negative and a complete responder who has microscopic nests of cells. Unless you've mapped out the tumor well, how do you know where to bio...

Data from the International Watch and Wait Database recently published in the Lancet (Lancet 391:2537-2545, 2018) confirm that there is 25% regrowth rate.