Retrospective cohort study of organ preservation with watch and wait in patients with stage II or III rectal cancer

With growing evidence and evolving guidelines, organ preservation with watch and wait (W&W) for stage II or III rectal cancer after neoadjuvant therapy is increasingly implemented. However, the true frequency of W&W use is unknown. A retrospective cohort study using the National Cancer Database investigated rates of intentional organ preservation among patientswith stage II or III rectal canceer diagnosed between 2006 and 2023 who received neoadjuvant chemoradiation in Commission on Care-accredited hospitals across the US. The primary outcome consisted of W&W rates, defined as excess nonsurgical management greater than baseline. To account for nonsurgical management unrelated to the decision for W&W, joinpoint regression estimated baseline rates of nonsurgical management and annual percentage changes. Among 101 001patients, 84 324 underwent surgery and 16 677 did not. Baseline rates of nonsurgical management remained stable through 2014. Joinpoints occurred in 2014 and 2019, with annual percentage changes of -0.45% in 2006 to 2014, 9.83% in 2015 to 2018, and 21.71% in 2019 to 2023. The rates of nonsurgical management were highest among older patients. Overall, W&W rates increased from 2.30% in 2015 to 32.94% in 2023. Increasing year and older age were independently associated with nonsurgical management (both p<0.001). The authors conclude that in this study, W&W rates increased across all age groups, with a marked acceleration after 2019 suggesting evidence-concordant adoption of the W&W approach.