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J.Jpn. Surg. Soc.. 123(3): 247-254, 2022

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Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan

Takashi Akiyoshi, Toshiki Mukai, Yukiharu Hiyoshi, Toshiya Nagasaki, Tomohiro Yamaguchi, Yosuke Fukunaga

In Japan, total mesorectal excision (TME) and lateral pelvic lymph node dissection (LPLND) is the standard treatment for advanced low rectal cancer below the peritoneal reflection. However, the quality of life (QOL) of patients after TME is worsened due to permanent colostomy or bowel dysfunction. Recently, total neoadjuvant therapy, which delivers systemic chemotherapy and chemoradiotherapy (CRT) before surgery, has been developed, and the number of patients who can achieve a clinical complete response has increased. Accordingly, there has been growing interest in the watch and wait (WW) approach as an attractive option to preserve the rectum and improve QOL, in which immediate TME is omitted in patients with clinical complete response, and intensive surveillance for local regrowth is performed. The hurdle of the WW approach is the lack of uniform, reproducible criteria for patient selection. To minimize the oncological risk of patients with local regrowth due to delayed surgery, salvage surgery should be performed in a timely fashion. The appropriate introduction of the WW approach is desirable in Japan where neoadjuvant CRT is not the standard treatment.

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