SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Gastrointestinal Cancers: Colorectal Cancer
Watch-and-Wait Strategy for Locally Advanced Rectal Cancer After Neoadjuvant Chemoradiotherapy: A Comprehensive Review
Provisionally accepted
- 1Nankai University School of Medicine, Tianjin, China
- 2Department of oncology, Affiliated Jinling Hospital of Medical School of Nanjing University, Nanjing, China
- 3Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- 4Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- 5Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- 6Department of Colorectal Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Tianjin, China
- 7Department of Scientific and Technology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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The conventional treatment for locally advanced rectal cancer (LARC) primarily involves neoadjuvant chemoradiotherapy (nCRT) combined with total mesorectal excision (TME). However, surgery-related complications and long-term functional impairments can significantly compromise patients' quality of life. The watch-and-wait (W&W) strategy has emerged as a non-surgical alternative for patients achieving a clinical complete response (cCR), with advantages in organ preservation. Its safety and efficacy have been validated by multiple clinical studies. Literature retrieval was performed in PubMed (2020 – 2025), including reviews, RCTs/cohort studies on LARC W&W and cCR/pCR. This comprehensive review summarizes the clinical evidence, patient selection criteria, efficacy assessment methods, challenges, and future directions of the W&W strategy. Based on the latest research, when strictly selecting cCR patients (especially those with sustained cCR after neoadjuvant therapy), the 5-year disease-free survival (DFS) rate of the W&W strategy is comparable to that of the surgical group (70%-85%), with a local regrowth rate of approximately 20%-30%, which can mostly be controlled by salvage surgery. The combination of magnetic resonance imaging (MRI) and circulating tumor DNA (ctDNA) analysis significantly improves the accuracy of cCR assessment. Furthermore, integrating immunotherapy with total neoadjuvant therapy (TNT) has expanded the eligible population for the W&W strategy. This review also highlights current limitations of the W&W strategy, such as the lack of standardized assessment procedures, validated biomarkers, and long-term follow-up data. It proposes that future efforts should focus on multi-center randomized controlled trials and artificial intelligence-assisted assessment models to promote the advancement of the W&W strategy toward precision and standardization.
Keywords: clinical complete response, Locally advanced rectal cancer, MRI, Neoadjuvant Therapy, watch-and-wait strategy
Received: 03 Dec 2025; Accepted: 30 Jan 2026.
Copyright: © 2026 Huang, Zhao, Fei, Zhang, Liu, Yu, Wu and Fei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Rong Wu
Fei Fei
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