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CC BY-NC-ND 4.0 · Journal of Coloproctology 2022; 42(04): 308-314
DOI: 10.1055/s-0042-1758206
Original Article

Watch and Wait, Worth It?

Manoel Álvaro de Freitas Lins Neto 
1   Coloproctology Service, Hospital Universitário Professor Alberto Antunes, Universidade Federal do Alagoas, Maceió, AL, Brazil
,
Luís Henrique Alves Salvador Filho 
1   Coloproctology Service, Hospital Universitário Professor Alberto Antunes, Universidade Federal do Alagoas, Maceió, AL, Brazil
,
Jorge Artur Peçanha de Miranda Coelho 
2   Coloproctology Service, Faculty of Medicine, Universidade Federal do Alagoas, Maceió, AL, Brazil
,
João Otávio de Moraes Rolim 
1   Coloproctology Service, Hospital Universitário Professor Alberto Antunes, Universidade Federal do Alagoas, Maceió, AL, Brazil
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Abstract

Background The surgery with total mesorectal excision recommended by R. J. Heald in 1982 is the gold standard. Rectal cancer (RC) surgery has a morbidity rate ranging from 6 to 35%, and it can cause functional issues such as sexual, urinary, and bowel dysfunction in the long term. Neoadjuvant chemoradiotherapy (CRT) has been gaining ground in patients with lesions in the middle and lower rectum. The aim of the present study is to present the experience of a reference service in the treatment of RC.

Patients and Methods A retrospective study involving 53 patients diagnosed with RC between January 2017 and December 2019 with follow-up until December 2020. We examined tumor location, disease stage, digital rectal exam findings, carcinoembryonic antigen (CEA), therapeutic modality offered, and follow-up time.

Results A total of 32% of the patients were men and 68% were women, with a mean age of 60 years old. Location: upper rectum in 6 cases, middle rectum in 21 cases, and lower rectum in 26 cases with evolution from 9.8 to 13.5 months. The most frequent complaints were hematochezia and constipation. A total of 36 patients underwent neoadjuvant therapy: 11 complete clinical response (CCR) (30.5%), 20 (55.5%) partial clinical response (PCR), and no response in 5 patients (14%). The follow-up ranged from 12 to 48 months, with a mean of 30.5 months. A total of 25% of the patients had RC that went beyond the mesorectal fascia, and 22.64% had metastases in other parts of the body when they were diagnosed.

Conclusion Neoadjuvant radio and chemotherapy present themselves as an alternative in the treatment of rectal cancer. In 36 patients, 30.5% had a complete clinical response, 55.5% had a partial clinical response, and 14% had no response. It was worth doing the “Watch and Wait” (W&W) to sample. A definitive colostomy was avoided. However, it is necessary to expand the study to a larger follow-up and more patients. Additionally, it is necessary to implement a multicenter study.

Keywords

rectum cancer - neoadjuvant - neoplasms - colorectal surgery - watch and wait


Publication History

Received: 05 June 2022

Accepted: 15 September 2022

Article published online:
22 December 2022

© 2022. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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