The 'watch-and-wait' (non-operative management) strategy after neoadjuvant chemoradiotherapy in rectal cancer is applicable only when which finding is confirmed?

• A Partial response with > 50% tumour volume reduction on MRI
• B Near-complete response with only mucosal irregularity on endoscopy
• C Clinical complete response (cCR): no residual tumour on DRE, endoscopy, and MRI ✓
• D Normalisation of CEA to < 2.5 ng/mL after chemoradiation

Explanation

Watch-and-wait (WW) for rectal cancer after neoadjuvant CRT requires clinical complete response defined by all three criteria: normal digital rectal exam (no palpable tumour), endoscopic assessment showing only whitening/telangiectasia without residual ulceration or mass, and MRI showing T-signal normalisation with no residual tumour signal. Near-complete response (shallow ulcer remaining) is not WW-eligible. CEA alone is insufficient. WW is associated with organ preservation in ~80% of true cCR cases.

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.