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Session:: ePosters-Mon800-M1: Rectal Cancer

EP713 - From Observation to Operation: Outcomes of Watch-and-Wait Salvage Surgery

Monday, May 11, 2026
8:21 AM - 8:26 AM ET

    ePoster Presenter(s)

  • Andrew Broussard, MD

    General Surgery Resident
    Ochsner Clinic Foundation
    Ochsner Clinic Foundation
    New Orleans, LA, United States

    Disclosure information not submitted.

    • Author(s)

  • Cora Ianiro, MD

    Research Fellow
    Ochsner Medical Center
    Ochsner Medical Center
    New Orleans, LA, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Jennifer L. Paruch, MD (she/her/hers)

    Surgeon, Principal Investigator
    Ochsner Medical Center
    Ochsner Medical Center
    New Orleans, Louisiana, United States

    Disclosure information not submitted.

    • Author(s)

  • W. Forrest Johnston, MD

    Program Director, Senior Staff Surgeon
    Ochsner Health
    University of Queensland
    New Orleans, LA, United States

    Disclosure information not submitted.

  • BK

    Brian R. Kann, MD (he/him/his)

    Chair, Dept of Colon & Rectal Surgery
    Ochsner Medical Center
    New Orleans, LA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

  • William C. Kethman, MD (he/him/his)

    Surgeon
    Ochsner Medical Center
    Ochsner Health
    New Orleans, LA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no relevant relationships with ineligible companies.

  • MZ

    Matthew Zelhart, MD

    Vice Chair
    Ochsner Medical Center
    New Orleans, Louisiana, United States

    Disclosure information not submitted.

  • CW

    Charles Whitlow, MD

    Surgeon
    Ochsner Medical Center
    New Orleans, Louisiana, United States

    Disclosure information not submitted.

  • DK

    Danielle Kay, MD

    Disclosure information not submitted.

  • SS

    Steven Schuetz, MD

    Ochsner Medical Center

    Disclosure information not submitted.

  • Connie C. Shao, MD, MSPH (she/her/hers)

    Resident
    Ochsner Medical Center
    Ochsner Medical Center
    New Orleans, LA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Brian R. Kann, MD: This individual has no relevant relationships with ineligible companies.
William C. Kethman, MD: This individual has no relevant relationships with ineligible companies.
Connie C. Shao, MD, MSPH: This individual has no financial relationships with ineligible companies.
Purpose/Background: Increasing evidence for the initial non-operative management of patients with locally advanced rectal cancer has accelerated its adoption. "Watch-and-wait" (W&W) protocols for patients achieving complete clinical response (cCR) or near complete response (nCR) after total neoadjuvant therapy (TNT) are now being more routinely adopted. However, the implications of local regrowth or disease persistence and subsequent surgery remain a critical area of study. We sought to evaluate the perioperative and oncologic outcomes of these patients.

Methods/Interventions: We conducted a retrospective review of our institutional rectal cancer database from July 2019 to October 2024, identifying patients with either a cCR and nCR in our W&W protocol. Outcomes assessed included rate of local regrowth, organ preservation interval (time interval from initial diagnosis to definitive surgical resection), circumferential radial margin status, anastomotic complications, and incidence of low anterior resection syndrome (LARS).

Results/Outcomes: We identified 73 patients with either cCR (49) or nCR (24) on restaging. At initial diagnosis, 67 of 73 (92%) had T3/T4 disease and 54 of 73 (74%) were node positive on imaging criteria. Most patients, 57/73 (78%), received long-course radiotherapy, while 16/73 (22%) received short-course radiotherapy. Over a 5-year period, 21.9% (16/73) developed local regrowth. Local regrowth occurred in 10 of 49 cCR patients (20.4%) and 6 of 24 nCR (25%) on surveillance. Local regrowth rates among short-course versus long-course radiation patients were 3/16 (18.8%) and 12/57 (21.2%), respectively. Fifteen patients underwent salvage surgery, while one patient declined. The mean time interval from TNT completion to local regrowth was 356.1 days (SD= 209.9). Mean organ preservation interval was 679.5 days (SD= 243.6). Salvage procedures included: abdominoperineal resection (7), low-anterior resection (4), transanal excision (3), and pelvic exenteration (1). No anastomotic complications were reported and all patients with diverting ileostomies underwent successful reversal. On final pathology two patients (13%) had a complete pathologic response, and one (8%) had a positive circumferential resection margin and subsequently died from complications of disease progression. Two of the three patients who underwent low-anterior resection (66%) reported LARS.

Conclusion/Discussion: Our institutional experience with W&W aligns with the findings from the benchmark trials reporting local regrowth rates of approximately 20-30% with successful definitive resection in most cases. These results support the use of W&W as an organ-preserving strategy outside of clinical trials in rectal cancer management.