{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:53:31Z","timestamp":1791161611497,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n \n Watch and wait strategies offer organ preservation for selected patients with rectal cancer following neoadjuvant chemoradiotherapy (\n nCRT<\/jats:styled-content>\n ). Long\u2010term outcomes following\n nCRT<\/jats:styled-content>\n and total mesorectal excision (\n TME<\/jats:styled-content>\n ) provide important context for evaluating these approaches. We report regional surgical, pathological, and long\u2010term oncological outcomes following\n nCRT<\/jats:styled-content>\n and\n TME<\/jats:styled-content>\n , with oncological outcomes stratified by treatment response.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A multicentre retrospective cohort study included patients with rectal cancer treated with curative\u2010intent\n nCRT<\/jats:styled-content>\n followed by\n TME<\/jats:styled-content>\n across four Western Australian centres between 2006 and 2020. Overall survival (\n OS<\/jats:styled-content>\n ), cancer\u2010specific survival (\n CSS<\/jats:styled-content>\n ), and disease\u2010free survival (\n DFS<\/jats:styled-content>\n ) were estimated using Kaplan\u2013Meier methods. Local and metastatic recurrence were estimated using cumulative incidence functions, with death without the recurrence of interest treated as a competing event. Outcomes were stratified by baseline clinical stage, pathological stage, and American Joint Committee on Cancer (\n AJCC<\/jats:styled-content>\n ) tumour regression grade (\n TRG<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 573 patients, anastomotic leak occurred in 10.8% of patients with an anastomosis and an intended permanent stoma was formed in 31.9%. A pathological complete response occurred in 21.8%, and 3.1% had a positive circumferential resection margin. Five\u2010year\n OS<\/jats:styled-content>\n was 85.7%,\n CSS<\/jats:styled-content>\n was 89.3% and\n DFS<\/jats:styled-content>\n was 76.7%. The five\u2010year cumulative incidences of local and metastatic recurrence were 3.4% and 16.5%, respectively. Baseline clinical stage was not associated with oncological outcomes, whereas pathological stage and\n AJCC TRG<\/jats:styled-content>\n provided significant prognostic stratification. Five\u2010year\n DFS<\/jats:styled-content>\n was 92.2% for\n TRG<\/jats:styled-content>\n 0% and 62.9% for\n TRG<\/jats:styled-content>\n 3, with corresponding metastatic recurrence of 3.9% and 24.9%.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Long\u2010course nCRT followed by TME achieved favourable long\u2010term oncological outcomes. Pathological stage and AJCC TRG provided greater prognostic stratification than baseline clinical stage. These response\u2010stratified estimates provide regional context for evaluating contemporary organ\u2010preservation programmes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ans.70998","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:44:41Z","timestamp":1791161081000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Word of Caution: Watch and Wait in the Total Mesorectal Excision Era"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7084-8985","authenticated-orcid":false,"given":"K.","family":"Broughton","sequence":"first","affiliation":[{"name":"Department of General Surgery Fiona Stanley Hospital Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9772-4571","authenticated-orcid":false,"given":"R.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of General Surgery Fiona Stanley Hospital Perth Australia"},{"name":"Medical School The University of Western Australia Perth Australia"},{"name":"School of Medicine The University of Notre Dame Fremantle Australia"},{"name":"Colorectal Research Unit St John of God Healthcare Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7867-8952","authenticated-orcid":false,"given":"A.","family":"Armanios","sequence":"additional","affiliation":[{"name":"Department of General Surgery Fiona Stanley Hospital Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Jamin","sequence":"additional","affiliation":[{"name":"Medical School The University of Western Australia Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Eguare","sequence":"additional","affiliation":[{"name":"Department of General Surgery Fiona Stanley Hospital Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of General Surgery Fiona Stanley Hospital Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of General Surgery Fiona Stanley Hospital Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Maclean","sequence":"additional","affiliation":[{"name":"Department of General Surgery Fiona Stanley Hospital Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3400-6120","authenticated-orcid":false,"given":"M.","family":"Teoh","sequence":"additional","affiliation":[{"name":"Department of General Surgery Fiona Stanley Hospital Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0491-4283","authenticated-orcid":false,"given":"M.","family":"Nyandoro","sequence":"additional","affiliation":[{"name":"Department of General Surgery Fiona Stanley Hospital Perth Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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