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Short-term outcomes from the 'Watch and Wait' (WoW) study : prospective cohort study

Rydbeck, Daniel ; Azhar, Najia LU orcid ; Blomqvist, Lennart ; Chabok, Abbas ; Folkesson, Joakim ; Gerdin, Anders ; Hermus, Linda ; Matthiessen, Peter ; Martling, Anna and Nilsson, Per J , et al. (2025) In BJS Open 9(1). p.1-6
Abstract

BACKGROUND: Despite absence of level 1 evidence on the long-term oncological safety of non-operative management for rectal cancer (watch and wait), increased implementation has occurred globally over the past decades. In Sweden, a pan-national prospective non-randomized study was initiated in 2017 to assess its implementation.

METHOD: Patients with biopsy-proven rectal cancer receiving neoadjuvant therapy according to national guidelines in whom a clinical complete response was detected at reassessment were eligible for inclusion following informed consent. Only patients with an opportunistic watch-and-wait approach were included. Inclusion and follow-up, according to the study protocol, was managed at the participating study... (More)

BACKGROUND: Despite absence of level 1 evidence on the long-term oncological safety of non-operative management for rectal cancer (watch and wait), increased implementation has occurred globally over the past decades. In Sweden, a pan-national prospective non-randomized study was initiated in 2017 to assess its implementation.

METHOD: Patients with biopsy-proven rectal cancer receiving neoadjuvant therapy according to national guidelines in whom a clinical complete response was detected at reassessment were eligible for inclusion following informed consent. Only patients with an opportunistic watch-and-wait approach were included. Inclusion and follow-up, according to the study protocol, was managed at the participating study centres. The primary outcome measure of the study is 3-year disease-free survival. Here, the secondary short-term outcomes local regrowth rate, distant metastasis rate and outcomes after surgery for regrowth, at 6 months follow-up, are reported.

RESULTS: Between January 2017 and February 2023, 211 patients with a clinical complete response were included in the study. Thirty-three (16%) patients developed suspicious regrowth within 6 months of inclusion. Thirty-two of 33 patients had abdominal resectional surgery for regrowth. The curative intention rate was 94% for patients with regrowth. Three patients (1.4%) developed distant metastases within 6 months of inclusion.

CONCLUSION: This Swedish national study on watch and wait reports regrowth rates after 6 months are in line with previous reports in the literature. Nearly all patients with early regrowth could be treated with salvage surgery and curative intent.

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organization
publishing date
type
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publication status
published
subject
keywords
Humans, Prospective Studies, Male, Female, Rectal Neoplasms/therapy, Watchful Waiting, Aged, Sweden, Middle Aged, Neoadjuvant Therapy, Disease-Free Survival, Neoplasm Recurrence, Local, Adult, Aged, 80 and over, Treatment Outcome
in
BJS Open
volume
9
issue
1
article number
zrae151
pages
1 - 6
publisher
Wiley
external identifiers
  • scopus:85216305571
  • pmid:39851200
ISSN
2474-9842
DOI
10.1093/bjsopen/zrae151
language
English
LU publication?
yes
additional info
© The Author(s) 2025. Published by Oxford University Press on behalf of BJS Foundation Ltd.
id
afa54c8e-f1c5-47d5-a8a0-b3bfeb96699d
date added to LUP
2025-02-02 21:06:02
date last changed
2025-07-12 15:41:20
@article{afa54c8e-f1c5-47d5-a8a0-b3bfeb96699d,
  abstract     = {{<p>BACKGROUND: Despite absence of level 1 evidence on the long-term oncological safety of non-operative management for rectal cancer (watch and wait), increased implementation has occurred globally over the past decades. In Sweden, a pan-national prospective non-randomized study was initiated in 2017 to assess its implementation.</p><p>METHOD: Patients with biopsy-proven rectal cancer receiving neoadjuvant therapy according to national guidelines in whom a clinical complete response was detected at reassessment were eligible for inclusion following informed consent. Only patients with an opportunistic watch-and-wait approach were included. Inclusion and follow-up, according to the study protocol, was managed at the participating study centres. The primary outcome measure of the study is 3-year disease-free survival. Here, the secondary short-term outcomes local regrowth rate, distant metastasis rate and outcomes after surgery for regrowth, at 6 months follow-up, are reported.</p><p>RESULTS: Between January 2017 and February 2023, 211 patients with a clinical complete response were included in the study. Thirty-three (16%) patients developed suspicious regrowth within 6 months of inclusion. Thirty-two of 33 patients had abdominal resectional surgery for regrowth. The curative intention rate was 94% for patients with regrowth. Three patients (1.4%) developed distant metastases within 6 months of inclusion.</p><p>CONCLUSION: This Swedish national study on watch and wait reports regrowth rates after 6 months are in line with previous reports in the literature. Nearly all patients with early regrowth could be treated with salvage surgery and curative intent.</p>}},
  author       = {{Rydbeck, Daniel and Azhar, Najia and Blomqvist, Lennart and Chabok, Abbas and Folkesson, Joakim and Gerdin, Anders and Hermus, Linda and Matthiessen, Peter and Martling, Anna and Nilsson, Per J and Angenete, Eva}},
  issn         = {{2474-9842}},
  keywords     = {{Humans; Prospective Studies; Male; Female; Rectal Neoplasms/therapy; Watchful Waiting; Aged; Sweden; Middle Aged; Neoadjuvant Therapy; Disease-Free Survival; Neoplasm Recurrence, Local; Adult; Aged, 80 and over; Treatment Outcome}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{1--6}},
  publisher    = {{Wiley}},
  series       = {{BJS Open}},
  title        = {{Short-term outcomes from the 'Watch and Wait' (WoW) study : prospective cohort study}},
  url          = {{http://dx.doi.org/10.1093/bjsopen/zrae151}},
  doi          = {{10.1093/bjsopen/zrae151}},
  volume       = {{9}},
  year         = {{2025}},
}