Wen R B, Zhang W
Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai 200433, Ghina.
Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Mar 25;23(3):230-236. doi: 10.3760/cma.j.cn.441530-20200224-00082.
In 2004, Habr-Gama reported a new group of rectal cancer patients achieving clinical complete response (cCR) after neoadjuvant chemoradiotherapy, who were able to get a satisfactory curative effect after a non-operative watch and wait (W&W) strategy. Since then, W&W has attracted more and more public attention. Although results of accumulating clinical studies have shown that W&W strategy is feasible for treating part of rectal cancer patients, there is still a lack of evidence-based medical evidence. Therefore, the feasibility and safety of the strategy still need further investigation. The main focuses are on the optimized scheme of chemoradiotherapy, the timing and standard to evaluate a cCR, and the shortage of a more precise approach to judging and predicting cCR. Whether a salvage surgery is safe and feasible for local regeneration, the risk of increasing distant metastasis and long-term oncologic and functional outcomes of patients also remain uncertain. Based on the literature and the institute's experience, this paper will elaborate the current development status and existing problems of W&W and look forward to the application prospect and future challenges.
2004年，哈布尔-伽马报告了一组新的直肠癌患者，他们在新辅助放化疗后实现了临床完全缓解（cCR），并在采取非手术观察等待（W&W）策略后获得了满意的疗效。从那时起，观察等待策略就越来越受到公众关注。尽管越来越多的临床研究结果表明，观察等待策略对于部分直肠癌患者的治疗是可行的，但仍然缺乏循证医学证据。因此，该策略的可行性和安全性仍需进一步研究。主要关注点在于放化疗的优化方案、评估cCR的时机和标准，以及缺乏更精确的判断和预测cCR的方法。挽救性手术对于局部复发是否安全可行、远处转移增加的风险以及患者的长期肿瘤学和功能预后也仍不确定。基于文献和该机构的经验，本文将阐述观察等待策略的当前发展现状和存在的问题，并展望其应用前景和未来挑战。
