Balancing watch and wait in rectal cancer treatment

Watch and Wait: Rethinking Rectal Cancer Treatment for Better Quality of Life

Soraya Malik in Health & Wellness December 2025 • 4 min read.

"Can avoiding surgery after chemoradiation lead to a happier, healthier recovery for rectal cancer patients?"

The standard treatment for locally advanced rectal cancer often involves a combination of chemotherapy, radiation, and surgery to remove the rectum (total mesorectal excision or TME). While this approach is effective at treating the cancer, it can also lead to long-term side effects that significantly impact a patient's quality of life. These side effects can include bowel dysfunction, sexual problems, and urinary issues.

However, a subset of patients – about 15-20% – experience a complete or near-complete response to chemotherapy and radiation, where the tumor disappears or shrinks dramatically. This raises a crucial question: do these patients necessarily need surgery, or can they be safely monitored with a 'watch-and-wait' approach?

The 'watch-and-wait' strategy involves closely observing the patient through regular checkups, scans, and examinations, intervening with surgery only if the cancer regrows. The goal is to preserve the rectum and its functions, thereby improving the patient's quality of life. This article explores the findings of a study comparing the quality of life of rectal cancer patients who underwent watch-and-wait versus those who had standard surgery after chemoradiation.

The Study: Comparing Watch-and-Wait to Standard Resection

Balancing watch and wait in rectal cancer treatment

Researchers in the Netherlands conducted a matched-controlled study to compare the quality of life of patients who underwent a watch-and-wait approach with those who had standard surgery (TME) after chemoradiation. The study included 41 patients in each group, carefully matched for factors like age, sex, tumor stage, and tumor location. All patients had been disease-free for at least two years at the time of the study.

Quality of life was assessed using a variety of validated questionnaires that covered different aspects of well-being, including:

General quality of life (SF-36, EORTC QLQ-C30)
Disease-specific quality of life related to rectal cancer and its treatment (EORTC QLQ-CR38)
Bowel function and defecation problems (Vaizey score, LARS score)
Sexual function (IIEF for men, FSFI for women)
Urinary function (IPSS)

The results revealed some significant differences between the two groups. Patients in the watch-and-wait group reported:

The Future of Rectal Cancer Treatment

This study adds to the growing body of evidence supporting the watch-and-wait approach as a viable option for select rectal cancer patients who achieve a complete response to chemoradiation. By avoiding surgery, many patients can experience a better quality of life, with fewer bowel, sexual, and urinary problems.

However, it's important to remember that watch-and-wait is not for everyone. Patients need to be closely monitored, and surgery may still be necessary if the cancer regrows. More research is needed to identify the ideal candidates for this approach and to optimize follow-up strategies.

As cancer treatment continues to evolve, the focus is shifting towards personalized approaches that consider not only the effectiveness of the treatment but also its impact on the patient's overall well-being. The watch-and-wait strategy exemplifies this shift, offering a potential path towards a happier, healthier future for some rectal cancer patients.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1097/dcr.0000000000000862, Alternate LINK

Title: Quality Of Life In Rectal Cancer Patients After Chemoradiation: Watch-And-Wait Policy Versus Standard Resection – A Matched-Controlled Study

Subject: Gastroenterology

Journal: Diseases of the Colon & Rectum

Publisher: Ovid Technologies (Wolters Kluwer Health)

Authors: Britt J.P. Hupkens, Milou H. Martens, Jan H. Stoot, Maaike Berbee, Jarno Melenhorst, Regina G. Beets-Tan, Geerard L. Beets, Stéphanie O. Breukink

Published: 2017-10-01

Everything You Need To Know

What is the 'watch-and-wait' strategy for treating rectal cancer, and what are its goals?

The 'watch-and-wait' strategy is a method of managing rectal cancer after chemoradiation where, instead of immediate surgery involving total mesorectal excision (TME), patients are closely monitored through regular checkups, scans, and examinations. Surgery is only performed if the cancer regrows. The primary aim is to preserve the rectum and its functions, potentially leading to a better quality of life by avoiding side effects associated with surgery.

What does standard treatment for rectal cancer usually involve, and what are its potential drawbacks?

Standard treatment for locally advanced rectal cancer typically involves a combination of chemotherapy, radiation, and surgery, specifically total mesorectal excision (TME). While effective in treating cancer, this approach can lead to long-term side effects such as bowel dysfunction, sexual problems, and urinary issues, which can significantly decrease a patient's quality of life. The 'watch-and-wait' approach aims to mitigate these side effects.

How was the quality of life compared between patients undergoing 'watch-and-wait' and those having standard surgery after chemoradiation in the Netherlands study?

The Dutch study compared the quality of life of rectal cancer patients who underwent the 'watch-and-wait' approach with those who had standard surgery (total mesorectal excision, TME) after chemoradiation. Researchers matched 41 patients in each group based on age, sex, tumor stage, and location. Quality of life was assessed using questionnaires covering general well-being (SF-36, EORTC QLQ-C30), disease-specific concerns (EORTC QLQ-CR38), bowel function (Vaizey score, LARS score), sexual function (IIEF for men, FSFI for women), and urinary function (IPSS).

In the study, what differences in quality of life were observed between patients who underwent 'watch-and-wait' and those who had standard surgery (total mesorectal excision, TME)?

Patients in the 'watch-and-wait' group reported statistically significant improvements in several areas compared to those who underwent total mesorectal excision (TME). They experienced better bowel function, reduced defecation problems as measured by the Vaizey and LARS scores, and improved sexual and urinary function based on IIEF, FSFI and IPSS assessments. The 'watch-and-wait' approach is proving better quality of life in disease free patients.

What are the implications of the study's findings for the future of rectal cancer treatment, and what further research is needed?

The findings suggest that 'watch-and-wait' is a viable option for a subset of rectal cancer patients, specifically those who have a complete or near-complete response to chemoradiation. By carefully selecting patients for this approach and closely monitoring them, it may be possible to avoid surgery (total mesorectal excision, TME) and its associated side effects, leading to improved quality of life without compromising cancer outcomes. Further research is needed to refine patient selection criteria and long-term monitoring strategies to ensure the safety and effectiveness of this approach.