الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
The current standard of care for patients with T3 or T4 and/or node-positive rectal adenocarcinoma is to offer preoperative concomitant chemoradiotherapy (CRT) followed by total mesorectal excision (TME). 1 In 10–24% of patients, no residual tumor is found at histology after surgery
Recently, a more conservative treatment is advocated in patients who show a good or complete response to neoadjuvant treatment. The long-term results of a prospective trial that investigated a “wait-and-see” policy in a carefully selected group of patients with clinical and radiological evidence of a complete response after neoadjuvant CRT.
Recently, A watch and wait policy avoids the morbidity associated with radical surgery and preserves oncologic outcomes. It could be considered a therapeutic option in patients with locally advanced rectal cancer following chemoradiotherapy with a complete clinical response
To safely omit surgery, it is essential to select accurately the right candidates, i.e., the true complete responders. This selection is mainly performed using digital examination, endoscopy, and biopsy, but these methods are not infallible
Complete pathologic response (pCR) after CRT has led to the proposal of a nonoperative approach as an alternate treatment for highly selected patients with a complete clinical response (CR). Findings from 99 patients with a clinical CR were reported who were treated with observation alone. The 5-year OS and DFS rates were 93% and 85%, respectively.