Watch and wait (non-operative management) after total neoadjuvant therapy for rectal cancer achieving clinical complete response (cCR) is most reliably confirmed by which combination?
- A Clinical examination (DRE), flexible endoscopy, and pelvic MRI — all showing cCR ✓
- B MRI showing T0N0 and CEA normalisation
- C PET-CT showing no FDG activity in the rectal region
- D Negative core biopsy from the primary tumour site
Correct answer: A. Clinical examination (DRE), flexible endoscopy, and pelvic MRI — all showing cCR
Explanation
Clinical complete response (cCR) requires all three to be concordant: digital rectal examination showing no palpable tumour, flexible endoscopy showing flat/white scar without visible tumour (with negative biopsies), and pelvic MRI showing mrTRG 1 or 2 (complete/near-complete regression). Organ preservation (watch and wait) avoids morbid surgery in true responders but requires intensive surveillance (3-monthly for 2 years). Local regrowth (25–30%) is rescued by surgery in ~80% of cases.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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