EP969 - Compliance with the Watch-and-Wait Protocol in Patients with Rectal Cancer Who Achieved Complete Clinical Response

Tuesday, May 13, 2025

8:05 AM – 8:10 AM PT

ePoster Presenter(s)

Anastasiya Shchatsko, MD

fellow
AdventHealth Orlando
Orlando, FL, United States

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

Author(s)

Saba Balvardi, MD (she/her/hers)

Colorectal Surgery Fellow
AdventHealth Medical Group Colorectal Surgery
Orlando, FL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Morgan Brazelle, MD (she/her/hers)

resident
AdventHealth Orlando
Orlando, FL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Arshad Bachelani, MD, FACS

Surgeon
AdventHealth
Venetia, PA, United States

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

Colorectal Fellow
Advent Health Orlando
Orlando, Florida, United States

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

Norberto Garcia-Henriquez, MD

Faculty
Advent health
Orlando, Florida, United States

Disclosure information not submitted.
Matthew Albert, MD

attending
AdventHealth
Orlando, Florida, United States

Disclosure information not submitted.
Mark Soliman, MD, FACS, FASCRS

Medical Director of Colorectal Surgery for the AdventHealth Digestive Health and Surgery Institute
AdventHealth
University of Central Florida
Orlando, Florida, United States

Disclosure information not submitted.
YT

Yaphet Tilahun, MD, FACS

Colorectal Surgeon
AdventHealth
Winter park, Florida, United States

Disclosure information not submitted.

Senior Author(s)

Christopher T. Aquina, MD, MPH

Attending
AdventHealth Orlando
Orlando, Florida, 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.

Anastasiya Shchatsko, MD: This individual has no financial relationships with ineligible companies.

Saba Balvardi, MD: This individual has no financial relationships with ineligible companies.

Morgan Brazelle, MD: This individual has no financial relationships with ineligible companies.

Arshad Bachelani, MD, FACS: This individual has no financial relationships with ineligible companies.

Yaniv Zager, MD: This individual has no financial relationships with ineligible companies.

Christopher T. Aquina, MD, MPH: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Neoadjuvant and total neoadjuvant therapy (TNT) for locally advanced rectal cancer has led to an increased rate of complete clinical response and subsequent organ preservation through a non-operative Watch-and-Wait (WW) approach. Careful surveillance including endoscopy, magnetic resonance imaging (MRI), and computed tomography (CT) imaging of these patients is paramount, as the majority of recurrences occur during the first 2 years. Compliance with a WW protocol was evaluated as compliance data are currently lacking.

Methods/Interventions: A retrospective cohort analysis of adult patients with stage 1-3 rectal adenocarcinoma who underwent neoadjuvant therapy with a complete clinical response and who were subsequently managed by a WW strategy at our institution between December 2015 and February 2022 was performed. To adequately evaluate compliance with the WW protocol, patients who discontinued surveillance before the 1-year interval (due to recurrence, death, desire of surgery, or moving out of the area) were excluded from the analysis. Compliance with the WW protocol was defined as follows: 1) endoscopic evaluation (flexible sigmoidoscopy or colonoscopy) every 3 months for the first 2 years and then every 6 months for the next 3 years; 2) MRI of the rectum every 6 months for a total of 5 years; and 3) CT of the chest/abdomen/pelvis (CT CAP), conducted every 6 months for a total of 5 years. Positron emission tomography (PET) was an acceptable alternative to MRI or CT. Digital rectal examinations and CEA levels were part of the protocol but were not analyzed in this study. Demographic, socioeconomic, and oncologic characteristics of patients were analyzed. Linear regression analysis was performed.

Results/Outcomes: A total of 67 patients met inclusion criteria. The majority entered the WW protocol after 2019. Most patients were male 49 (73%), Caucasian 53 (79%), had stage III rectal cancer 47 (70%), and received TNT 44 (66%) (Table 1). The median follow-up was 3.6 years (33.7 months). Compliance with modes of surveillance ranged significantly from 0 to 100% (Table 2). Median overall compliance was 50% for endoscopic evaluation, 67% for MRI rectum/PET, and 50% for CT CAP/PET. Patient demographics, including age, sex, race, socioeconomic status, and distance to the treatment center, were not associated with compliance, except for a lower rate of compliance with MRI surveillance among male patients (p=0.02) during first year of WW.

Conclusion/Discussion: Compliance with different modes of surveillance in the Watch-and-Wait protocol is moderate. Further studies are needed to evaluate potential barriers to care and improve surveillance compliance.