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Session:: ePosters-Mon800-M1: Rectal Cancer

EP711 - Compliance With Watch-and-Wait Surveillance After Complete Clinical Response in Rectal Cancer: A Systematic Review and Meta-Analysis

Monday, May 11, 2026
8:10 AM - 8:15 AM ET

    ePoster Presenter(s)

  • Yaniv Zager, MD

    Colorectal Surgeon
    UMass Memorial
    UMass Chan medical school
    Worcester, MA, United States

    Disclosure information not submitted.

    View ePoster

    • Author(s)

  • Justin Maykel, MD

    Chief, Division of Colorectal Surgery
    UMass Memorial Health
    UMass Chan Medical School
    Worcester, MA, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.

    • Senior Author(s)

  • Nir Horesh, MD

    Resident Physician
    Cleveland Clinic Florida
    Tel Aviv University
    Weston, FL, United States

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Purpose/Background: The Watch-and-Wait (WW) strategy enables organ preservation in selected patients with rectal cancer who achieve a complete clinical response following neoadjuvant therapy. Adherence to structured surveillance protocols is essential to detect local regrowth and ensure timely salvage surgery. Data regarding patients' compliance with those regimens is still limited.

Methods/Interventions: A PRISMA-guided systematic search of PubMed and Google Scholar was performed on October 2, 2025. Eligible studies included adult patients with rectal adenocarcinoma managed non-operatively after complete clinical response, providing extractable adherence numerators and denominators. Demographic data as well as disease stage and compliance with endoscopic, imaging, tumor-markers and physical examination were collected. The statistical analysis was performed using open-source, cross-platform software tools: openMeta [Analyst]™ version 12.11.14 and Cochrane Review Manager 5.4 ®. P-value < 0.05 was considered statistically significant.

Results/Outcomes: Initial screening included 44 publications, of which 5 studies were included in the final analysis (all of them published in the USA between 2020-2025), comprising a total of 306 patients. Surveillance protocols were different among the publications and included institutional protocols as well as the National Comprehensive Cancer Network (NCCN) protocol. Median age was 61 (34-83) years. Overall, 182 (63.63%) were male, 233 (76.14%) patients were Caucasian and 107 (50.95%) had private medical insurance. Most patients had stage III disease (N=160, 61.78%), followed by stage II (N=63, 24.32%) and stage I (N=23, 8.89%). The majority underwent Total Neoadjuvant Therapy (TNT) (N=244, 79.74%) while Chemoradiotherapy (CRT) was given to 47 (15.36%) patients. The median follow-up was 33 (10-75) months. Fifty-four (17.2%) patients had local regrowth. Seventeen (9.5%) patients had distant metastatic recurrence.

In pooled analysis, the overall compliance was 44.1% (95 % CI 36.5-52.5 %, I2=52.31%). Overall Magnetic Resonance Imaging (MRI) compliance was 75% (95% CI 51.5-98.4%, I2=96.56%). Overall endoscopy compliance was 46.6% (95% CI 39.4-53.8%, I2=33.48%). MRI compliance decreased in the second year compared to the first year (OR=17.95, I2=82%, p< 0.01). Same for compliance with Computerized Tomography (CT) (OR=2.73, I2= 70%, p=0.04). Most publications do not report digital rectal examinations (DRE) separately but rather, adjacent to endoscopy. Only two publications included data regarding compliance with Carcinoembryonic Antigen (CEA) and it was presented non-uniformly.

Conclusion/Discussion: Adherence to surveillance protocols in Watch-and-Wait rectal cancer management is modest and declines substantially over time. Standardization of definitions and uniform reporting are warranted. Further interventions are warranted to enhance patients' compliance with nonoperative management for rectal cancer.