ACPGBI Advanced Malignancy Subcommittee, London, UK.
The Dukes Club, London, UK.
Colorectal Dis. 2023 Jul;25(7):1489-1497. doi: 10.1111/codi.16592. Epub 2023 May 1.
This article adopts a multidisciplinary approach, including surgery, oncology, radiology and patient perspectives, to discuss the key points of debate surrounding a watch and wait approach. In an era of shared decision-making, discussion of watch and wait as an option in the context of complete clinical response is appropriate, although it is not the gold standard treatment. Key challenges are the difficulty in assessing for a complete clinical response, prediction of recurrence and access to timely diagnostics for surveillance. Salvage surgery has good results if regrowth is detected early but does have imperfect outcomes, with only a 90% salvage rate. Good communication with patients about the risks and alternatives is essential. Patients undergoing watch and wait should ideally be enrolled in prospective registries or clinical trials.
本文采用多学科方法，包括手术、肿瘤学、放射学和患者观点，讨论围绕观望等待方法的关键争议点。在共同决策时代，在完全临床缓解的背景下讨论观望等待作为一种选择是合适的，尽管它不是黄金标准治疗。主要挑战在于评估完全临床缓解的难度、预测复发以及及时获得监测用诊断工具。如果早期发现复发，挽救性手术有良好的效果，但结局并不完美，只有 90%的挽救率。与患者就风险和替代方案进行良好的沟通至关重要。接受观望等待的患者最好纳入前瞻性登记或临床试验。
