A 58-year-old with a rectal cancer at 6 cm from the anal verge undergoes neoadjuvant long-course chemoradiotherapy. Post-treatment assessment shows clinical complete response (cCR). According to the 'watch and wait' strategy, what is the most important concern regarding this approach?

• A Increased distant metastasis rates compared to immediate surgery
• B Inability to perform salvage surgery after regrowth
• C Higher rates of permanent colostomy
• D Local regrowth occurring in approximately 25–30% of cases ✓

Explanation

In the 'watch and wait' strategy for rectal cancer with cCR after neoadjuvant chemoradiotherapy (as studied by Habr-Gama and others), approximately 25–30% of patients experience local regrowth, typically within 2 years of initial response. Crucially, approximately 80–90% of such regrowths are amenable to salvage resection with curative intent. Distant metastasis rates and overall survival are comparable to immediate surgery in well-selected patients. The main concern is early detection of regrowth through rigorous surveillance.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.