“Watch and Wait” Strategy Puts Surgery On Hold for Some With Rectal Cancer

BUFFALO, N.Y. — Imagine not having to think about surgery as part of cancer care. Researchers at Roswell Park Comprehensive Cancer Center are seeing encouraging results with a group of rectal cancer patients who were able to safely defer surgery rather than going under the knife.

The research, led by surgical oncologist Steven Nurkin, MD, MS, FACS, was published in Surgical Oncology this month and is one of the largest U.S. single-institution analyses evaluating neoadjuvant therapy and non-operative management, or NOM, in patients with rectal cancer.

Through a retrospective review of rectal cancer patients seen between 2012 and 2016, Dr. Nurkin and team identified 29 individuals who elected to “watch and wait” as part of their treatment plan. They did receive some treatment for their cancers — all 29 achieved complete clinical response (cCR) from chemotherapy and radiation therapy administered as a neoadjuvant, or preliminary step — but did not initially undergo surgery as part of their treatment. All 29 were followed with physical exams, endoscopy, and imaging.

A majority of these patients — 79% — were still cancer-free at median follow-up of 27 months. Six patients did experience recurrence of their cancer.

Although radical resection, or surgical removal of the rectum, is a standard treatment for many patients with rectal cancer, there can be negative side effects. Potential complications include anastomotic leak, and other quality of life issues such as incontinence and urinary/sexual dysfunction or need for a colostomy bag. Dr. Nurkin’s team explained while NOM is not currently considered the standard of care, it is offered based on previously published preliminary data.

“Patients should be able to choose the treatment that’s right for them,” says Dr. Nurkin, Associate Professor of Oncology in the Department of Surgical Oncology at Roswell Park. “Although these are still preliminary results, this strategy may be a way for someone to live a stoma-free life, preserve their quality of life and possibly offer another chance for cure.”

The study, “Nonoperative management after neoadjuvant therapy for rectal cancer: A single institution experience over 5 years,” is available at sciencedirect.com.

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Roswell Park Comprehensive Cancer Center is a community united by the drive to eliminate cancer’s grip on humanity by unlocking its secrets through personalized approaches and unleashing the healing power of hope. Founded by Dr. Roswell Park in 1898, it is the only National Cancer Institute-designated comprehensive cancer center in Upstate New York. Learn more at www.roswellpark.org, or contact us at 1-800-ROSWELL (1-800-767-9355) or ASKRoswell@RoswellPark.org.