ArticleAnnals of surgical oncology2025
Nonoperative Management of Rectal Cancer: Is "Near-Complete" Response Safe to Surveil?
Article in Annals of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Pre-operative endoscopic assessment and MRI as predictors of pathological complete response and long-term survival in locally advanced rectal cancer after neoadjuvant therapy.Surgical endoscopy · 2026Article
- Rectal Cancer Watch-and-Wait Management of Patients With Tumors Within Versus Beyond the Reach of Digital Rectal Examination.Annals of surgical oncology · 2026Article
Corrections and comments
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Authors and funding
17 authors.
Funding
Abstract
backgroundNonoperative management of rectal cancer in patients who achieve near-complete response following total neoadjuvant therapy remains controversial and understudied.
methodsThis retrospective cohort study conducted at a tertiary National Cancer Institute-designated cancer center included patients with rectal cancer who initiated active surveillance after achieving near-complete response following induction radiotherapy and consolidation chemotherapy. Near-complete response was determined based on restaging endoluminal evaluation and pelvic magnetic resonance imaging. Time-to-event analyses were used to estimate regrowth-free, proctectomy-free, disease-free, and overall survival.
resultsOf 61 patients who achieved near-complete response and initiated nonoperative management between February 2017 and March 2024, 36 (59.0%) maintained organ preservation with a median follow-up of 27.1 (interquartile range [IQR] 17.4-37.4) months. Twenty-five patients (41.0%) developed local regrowth by a median of 5.7 (IQR 3.2-8.2) months. All regrowths occurred within 17.5 months of initial restaging. Twenty-one patients with regrowth underwent salvage proctectomy, of which 20 (95.2%) achieved R0 resection margins. Following salvage proctectomy, four patients (19.0%) developed local recurrence. Disease-free and overall survival 2 years from restaging were 79.2% (95% confidence interval [CI] 67.0-93.6) and 93.3% (95% CI 86.3-100), respectively. Overall survival was not significantly different between patients with versus without local regrowth (log-rank p = 0.09).
conclusionsNonoperative management achieves clinically significant organ preservation rates without compromising oncologic outcomes in patients with near-complete response to total neoadjuvant therapy. Active surveillance allows time for continued evolution of tumor response and may substantially expand organ preservation in a patient population who otherwise would undergo avoidable radical surgery.
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