Complete Clinical Response in Rectal Cancer After Neoadjuvant Therapy: Organ Preservation Strategies and the Role of Surgery

  • Laura Melina Fernandez
  • Guilherme Pagin São Julião
  • Bruna Borba Vailati
  • Angelita Habr-Gama
  • Rodrigo O. Perez


The traditional concept of rectal cancer management has changed significantly over the last few years. Although surgical resection is still the main pillar in the management of distal rectal cancer by proctectomy and total mesorectal excision (TME), organ preservation strategies have gained popularity. Neoadjuvant chemoradiation (nCRT) may result in significant tumor regression and may lead to complete pathological response in up to 42% of patients. In an attempt to avoid considerable morbidity and functional consequences of proctectomy and TME, selected patients that develop complete clinical response to neoadjuvant chemoradiation have been offered organ-preserving strategies including transanal local excision or even no immediate surgery and strict follow-up (watch and wait (WW)) with acceptable oncological outcomes and minimal functional consequences. Transanal local excisions may be an attractive organ-preserving strategy in this setting by providing definitive confirmation of complete primary tumor regression after nCRT. However, specific issues in tumor regression patterns, wound healing, postoperative function, and surveillance may constitute significant disadvantages of this approach over watch and wait.


Rectal cancer Organ preservation Watch and wait Local excision Neoadjuvant chemoradiation 


Conflicts of Interest

The authors have no conflicts of interest to declare.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Laura Melina Fernandez
    • 1
  • Guilherme Pagin São Julião
    • 1
  • Bruna Borba Vailati
    • 1
  • Angelita Habr-Gama
    • 1
    • 2
  • Rodrigo O. Perez
    • 1
    • 2
    • 3
  1. 1.Angelita & Joaquim Gama InstituteSao PauloBrazil
  2. 2.Colorectal Surgery DivisionUniversity of São Paulo School of MedicineSao PauloBrazil
  3. 3.Ludwig Institute for Cancer Research São Paulo BranchSao PauloBrazil

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