Oncologic outcomes of watch-and-wait compared to tumor regression grades after total mesorectal excision in…

Cohort studyEuropean journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology· Jul 2026

Oncologic outcomes of watch-and-wait compared to tumor regression grades after total mesorectal excision in rectal cancer.

Jyi Cheng Ng, Richard Sassun, Annaclara Sileo … David W Larson

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Colon & Rectal SurgeryCohort studyPrognosisQ1IF 2.8

Patients with pathological complete response after surgery had 100% survival without recurrence at 3 years.

Oncologic outcomes of watch-and-wait compared to tumor regression grades after total mesorectal excision in rectal cancer.

Jyi Cheng Ng … David W Larson

European journal of surgical oncology · Jul 2026 · Q1 in Surgery

Background

Survival outcomes in patients managed nonoperatively ("watch-and-wait"; W&W) have been compared to those achieving pathological complete response after total mesorectal excision (total mesorectal excision).

Methods

The total mesorectal excision cohort was stratified by American Joint Committee on Cancer/College of American Pathologists tumor regression grade (tumor regression grade).

n = 385 patients

100%

Results

100%

no recurrences or spread at 3 years when tumor fully cleared

n = 385 patients

More results

Among 385 patients, 79 were in the W&W cohort; 306 underwent total mesorectal excision (81 TRG0, 75 TRG1, 114 TRG2, and 36 TRG3).

More results

W&W patients had significantly shorter tumor-anorectal junction distances, smaller tumors, less tumors with extramural vascular invasion on pretreatment MRI, less threatened/involved mesorectal fascia, and lower clinical T and N stages.

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Conclusion · 1 of 2

Despite favorable baseline characteristics, W&W patients had prognoses similar to total mesorectal excision patients with suboptimal responses.

Conclusion · 2 of 2

Nonoperative management is a viable option for well-selected patients prioritizing organ preservation, but its cancer control outcomes appear not to match the well-established efficacy of definitive oncological resection.

Oncologic outcomes of watch-and-wait compared to tumor regression grades after total mesorectal excision in rectal cancer.

Oncologic outcomes of watch-and-wait compared to tumor regression grades after total mesorectal excision in rectal cancer.

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