Challenges of Implementing the “Watch” in Watch-and-Wait for Rectal Cancer

Abstract Nonoperative management, or watch-and-wait, is an increasingly utilized treatment strategy for locally advanced rectal cancer both in the United States and internationally. Studies demonstrate acceptable oncologic outcomes for patients with clinical complete response (cCR) and close surveillance compared with those who undergo surgery after neoadjuvant therapy, but this strategy relies on multiple key factors to achieve optimal outcomes. Implementing watch-and-wait raises new challenges throughout the course of rectal cancer care, from treatment decision-making and offering watch-and-wait, throughout the course of surveillance which involves patients, providers, systems, and policy.