Delayed TME Surgery in a Watch and Wait Strategy After Neoadjuvant Chemoradiotherapy for Rectal Cancer: An Analysis of Hospital Costs, Surgical, and Oncological Outcomes

Vincent M Meyer*, Richtje R Meuzelaar, Ivonne J H Schoenaker, Jan-Willem B de Groot, Onne Reerink, Wouter H de Vos Tot Nederveen Cappel, Geerard L Beets, Henderik L van Westreenen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: A watch & wait strategy for patients with rectal cancer with a clinical complete response after neoadjuvant chemoradiotherapy is a valuable alternative for rectal resection. However, there are patients who will have residual tumor or regrowth during watch & wait.

OBJECTIVE: The aim was to investigate safety and costs for patients who underwent delayed surgery after neoadjuvant chemoradiotherapy.

DESIGN: This is a retrospective cohort study with prospectively collected data.

SETTINGS: The study was conducted at a large teaching hospital.

PATIENTS: Between Jan 2015 - May 2020, 622 new rectal cancer patients were seen of which 200 received neoadjuvant chemoradiotherapy. Ninety-four patients were included of which 65 patients underwent immediate surgery and 29 patients required delayed surgery after an initial watch & wait approach.

MAIN OUTCOME MEASURES: This included 30-day postoperative morbidity rate, hospital costs and two-year overall and disease-free survival.

RESULTS: There was no difference in length of stay (9 vs 8, p = 0.83), readmissions (27.6% vs 10.0%, p = 0.10), surgical re-interventions (15.0% vs 3.4%, p = 0.16) and stoma free rate (52.6% vs 31.0%, p = 0.09) between immediate and delayed surgery groups. Hospital costs were similar in the delayed group (€11913 vs €13769, p = 0.89). Two-year overall survival (93% vs 100%, p = 0.23) and disease-free survival (78% vs 81%, p = 0.47) rates were comparable.

LIMITATIONS: Small sample size, follow-up time and retrospective design.

CONCLUSION: Delayed surgery for regrowth in a watch & wait program or for persistent residual disease after a repeated assessment is not associated with an increased risk of postoperative morbidity or a significant rise in costs compared to immediate total mesorectal excision. There also appears to be no evident compromise in oncological outcome. Repeated response assessment in patients with a near complete clinical response after neoadjuvant chemoradiotherapy is a useful approach to identify more patients who can benefit from a watch & wait strategy. See Video Abstract at .

Original languageEnglish
Pages (from-to)671-680
JournalDiseases of the Colon & Rectum
Issue number5
Early online date24 Nov 2021
Publication statusPublished - 2023

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