Refusal of Surgery in Rectal Cancer: Shortened Survival Despite Some Achieving Complete Clinical Response

Rectal cancer patients who refused surgery despite incomplete response to neoadjuvant therapy had shortened overall survival (OS). Some patients converted to a complete clinical response (CCR) on subsequent staging, leading to prolonged OS. Patients with near CCR at initial endoscopic staging may benefit from prolonged monitoring before declaring CCR. Increased physician visits and testing were observed in patients who opted for a watch-and-wait approach or refused total mesorectal excision.