Colorectal Surgery

Who can safely avoid proctectomy? Practical contours of watch-and-wait for locally advanced rectal cancer

This Viewpoint synthesizes evidence for non-operative management (NOM) after complete clinical response in locally advanced rectal cancer. It notes that up to 40% of treated patients may avoid surgery, preserving rectal anatomy and long-term quality of life. For pMMR/MSS tumors, de-escalation typically follows treatment intensification with total neoadjuvant therapy before omitting surgery in complete responders. The article stresses standardized response assessment, close surveillance, and multidisciplinary review as prerequisites for safe watch-and-wait adoption. 1

Fecal hemoglobin levels refine post-polypectomy surveillance timing in FIT-based screening

This large FIT-based screening cohort examined fecal hemoglobin concentration (f-Hb) to individualize post-polypectomy surveillance intervals. Nearly 90,000 participants with f-Hb ≥20 μg/g and complete colonoscopy were followed for incident colorectal cancer. CRC incidence increased stepwise with rising baseline f-Hb, even within conventional high- and low-risk strata. Modelled f-Hb–guided intervals lengthened follow-up for low f-Hb and shortened it for high f-Hb, reducing colonoscopy demand by 9.8% without increasing CRC risk. 2

In veterans ≥75 with prior adenoma, CRC risk is low and overshadowed by non-CRC mortality

This VA retrospective cohort included more than 90,000 adults who had colonoscopy before age 75, with or without adenoma. At 10 years, cumulative CRC incidence and CRC death were low in both groups, only slightly higher after prior adenoma. Non-CRC mortality approached roughly half of patients at 10 years and exceeded CRC incidence across all frailty categories. Findings support deprioritizing surveillance colonoscopy in many adults ≥75, especially those with higher frailty or competing comorbidities. 3