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The WCGCCC is an interactive multidisciplinary conference that was attended by healthcare professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with colorectal cancer. Specialists from the fields of medical and radiation oncology, pathology, surgery, and a family physician in oncology participated in presentations and discussions for the purpose of developing the recommendations presented here. This consensus statement addresses recent advances in the management of colorectal cancer in a Western Canadian context, with respect to adjuvant exercise, as per the CHALLENGE trial, adjuvant Aspirin and PI3K testing, as per the ALASCCA trial, adjuvant immunotherapy, as per the ATOMIC trial, the use of encorafenib and an EGFR inhibitor with chemotherapy, as per the BREAKWATER trial, the use of combination immunotherapy as per the CHECKMATE 8HW trial and optimal strategies for omitting radiation and non-operative management of non-metastatic rectal cancer.<\/jats:p>","DOI":"10.3390\/curroncol33070437","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T10:35:52Z","timestamp":1784630152000},"page":"437","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Report from the 27th Annual Western Canadian Gastrointestinal Cancer Consensus Conference on Colorectal Cancer, Calgary, Alberta, 26\u201327 September 2025: Advances in Colon and Rectal Cancer"],"prefix":"10.3390","volume":"33","author":[{"given":"Richard","family":"Lee-Ying","sequence":"first","affiliation":[{"name":"Arthur J.E. 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J. Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1200\/JCO.22.00171","article-title":"Physical Activity in Stage III Colon Cancer: CALGB\/SWOG 80702 (Alliance)","volume":"41","author":"Brown","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1056\/NEJMoa2502760","article-title":"Structured Exercise after Adjuvant Chemotherapy for Colon Cancer","volume":"393","author":"Courneya","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/0749-5978(91)90020-T","article-title":"The theory of planned behavior","volume":"50","author":"Ajzen","year":"1991","journal-title":"Organ. Behav. Hum. Decis. 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Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1136\/gut.2009.203000","article-title":"Effect of aspirin and NSAIDs on risk and survival from colorectal cancer","volume":"59","author":"Din","year":"2010","journal-title":"Gut"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1016\/S0140-6736(07)60747-8","article-title":"Effect of aspirin on long-term risk of colorectal cancer: Consistent evidence from randomised and observational studies","volume":"369","author":"Flossmann","year":"2007","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/S1470-2045(12)70112-2","article-title":"Effects of regular aspirin on long-term cancer incidence and metastasis: A systematic comparison of evidence from observational studies versus randomised trials","volume":"13","author":"Algra","year":"2012","journal-title":"Lancet Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1016\/S0140-6736(11)61049-0","article-title":"Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: An analysis from the CAPP2 randomised controlled trial","volume":"378","author":"Burn","year":"2011","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"365","DOI":"10.7326\/0003-4819-146-5-200703060-00010","article-title":"The use of aspirin for primary prevention of colorectal cancer: A systematic review prepared for the U.S. Preventive Services Task Force","volume":"146","author":"Rostom","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1001\/jama.2009.1112","article-title":"Aspirin use and survival after diagnosis of colorectal cancer","volume":"302","author":"Chan","year":"2009","journal-title":"JAMA"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1016\/S0140-6736(10)61543-7","article-title":"Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials","volume":"376","author":"Rothwell","year":"2010","journal-title":"Lancet"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1002\/ijc.24757","article-title":"Cyclooxygenase-2 inhibition inhibits PI3K\/AKT kinase activity in epithelial ovarian cancer","volume":"126","author":"Uddin","year":"2010","journal-title":"Int. J. Cancer."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1007\/s13277-010-0078-9","article-title":"PI3-kinase\/Wnt association mediates COX-2\/PGE2 pathway to inhibit apoptosis in early stages of colon carcinogenesis: Chemoprevention by diclofenac","volume":"31","author":"Kaur","year":"2010","journal-title":"Tumour Biol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1056\/NEJMoa1207756","article-title":"Aspirin Use, Tumor PIK3CA Mutation, and Colorectal-Cancer Survival","volume":"367","author":"Liao","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/S2468-1253(24)00387-X","article-title":"Aspirin after completion of standard adjuvant therapy for colorectal cancer (ASCOLT): An international, multicentre, phase 3, randomised, double-blind, placebo-controlled trial","volume":"10","author":"Chia","year":"2025","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3142","DOI":"10.1158\/1078-0432.CCR-24-4048","article-title":"Adjuvant Aspirin Treatment in PIK3CA-Mutated Colon Cancer Patients: The SAKK 41\/13 Prospective Randomized Placebo-Controlled Double-Blind Trial","volume":"31","author":"Hayoz","year":"2025","journal-title":"Clin. Cancer. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"103822","DOI":"10.1016\/j.dnarep.2025.103822","article-title":"Advances in diagnostic and therapeutic applications of mismatch repair loss in cancer","volume":"147","author":"DeWitt","year":"2025","journal-title":"DNA Repair."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Sun, M., Monahan, K., Moquet, J., and Barnard, S. (2025). Colorectal cancers associated with mismatch repair deficiency. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1649565"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"4623","DOI":"10.1002\/cncr.26086","article-title":"Impact of BRAF mutation and microsatellite instability on the pattern of metastatic spread and prognosis in metastatic colorectal cancer","volume":"117","author":"Tran","year":"2011","journal-title":"Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2735","DOI":"10.1200\/JCO.21.02691","article-title":"Mismatch Repair-Deficient Colorectal Cancer: Building on Checkpoint Blockade","volume":"40","author":"Jin","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1056\/NEJMoa022289","article-title":"Tumor Microsatellite-Instability Status as a Predictor of Benefit from Fluorouracil-Based Adjuvant Chemotherapy for Colon Cancer","volume":"349","author":"Ribic","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3219","DOI":"10.1200\/JCO.2009.27.1825","article-title":"Defective mismatch repair as a predictive marker for lack of efficacy of fluorouracil-based adjuvant therapy in colon cancer","volume":"28","author":"Sargent","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1200\/JCO.20.01600","article-title":"Microsatellite Instability in Patients with Stage III Colon Cancer Receiving Fluoropyrimidine with or Without Oxaliplatin: An ACCENT Pooled Analysis of 12 Adjuvant Trials","volume":"39","author":"Cohen","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1038\/s41598-022-05065-6","article-title":"Survival benefit with adjuvant chemotherapy in stage III microsatellite-high\/deficient mismatch repair colon cancer: A systematic review and meta-analysis","volume":"12","author":"Tomasello","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_27","unstructured":"National Comprehensive Cancer Network [Internet] (2026, March 01). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines\u00ae): Colon Cancer (Version 5.2025). Available online: https:\/\/www.nccn.org\/guidelines\/category_1."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1016\/j.annonc.2020.06.022","article-title":"Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up\u2020","volume":"31","author":"Tabernero","year":"2020","journal-title":"Ann. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1126\/science.aan6733","article-title":"Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade","volume":"357","author":"Le","year":"2017","journal-title":"Science"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.annonc.2024.11.012","article-title":"Pembrolizumab versus chemotherapy in microsatellite instability-high or mismatch repair-deficient metastatic colorectal cancer: 5-year follow-up from the randomized phase III KEYNOTE-177 study","volume":"36","author":"Shiu","year":"2025","journal-title":"Ann. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2014","DOI":"10.1056\/NEJMoa2402141","article-title":"Nivolumab plus Ipilimumab in Microsatellite-Instability\u2013High Metastatic Colorectal Cancer","volume":"391","author":"Elez","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1056\/NEJMoa2507874","article-title":"Atezolizumab plus FOLFOX for Stage III Mismatch Repair-Deficient Colon Cancer","volume":"394","author":"Sinicrope","year":"2026","journal-title":"N. Engl. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e009722","DOI":"10.1136\/jitc-2024-009722","article-title":"Immune checkpoint blockade: Timing is everything","volume":"12","author":"Sinicrope","year":"2024","journal-title":"J. Immunother. Cancer"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"eaax0182","DOI":"10.1126\/science.aax0182","article-title":"Neoadjuvant checkpoint blockade for cancer immunotherapy","volume":"367","author":"Topalian","year":"2020","journal-title":"Science"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1038\/s41591-020-0805-8","article-title":"Neoadjuvant immunotherapy leads to pathological responses in MMR-proficient and MMR-deficient early-stage colon cancers","volume":"26","author":"Chalabi","year":"2020","journal-title":"Nat. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1056\/NEJMoa2400634","article-title":"Neoadjuvant Immunotherapy in Locally Advanced Mismatch Repair\u2013Deficient Colon Cancer","volume":"390","author":"Chalabi","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Shiu, K.K., Jiang, Y., Saunders, M., Seligmann, J.F., Iveson, T., Wilson, R.H., Graham, J.S., Khan, K.H., Militello, A.M., and Irvine, S. (2024). NEOPRISM-CRC: Neoadjuvant pembrolizumab stratified to tumour mutation burden for high-risk stage 2 or stage 3 deficient-MMR\/MSI-high colorectal cancer. Proceedings of the 2024 ASCO Annual Meeting II, Chicago, IL, USA, 31 May\u20134 June 2024, ASCO Publications.","DOI":"10.1200\/JCO.2024.42.17_suppl.LBA3504"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Qvortrup, C., Justesen, T.F., Tarpgaard, L.S., Bulut, M., Hansen, T., Rahr, H.B., Petersen, P.C., Eriksen, J.R., Salomon, S., and Gotschalck, K.A. (2025). Single-cycle neoadjuvant pembrolizumab in patients with stage I-III MMR-deficient colon cancer: Final analysis of the RESET-C study. Proceedings of the 2025 ASCO Gastrointestinal Cancers Symposium, San Francisco, CA, USA, 23\u201325 January 2025, ASCO Publications.","DOI":"10.1200\/JCO.2025.43.4_suppl.19"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2363","DOI":"10.1056\/NEJMoa2201445","article-title":"PD-1 Blockade in Mismatch Repair\u2013Deficient, Locally Advanced Rectal Cancer","volume":"386","author":"Cercek","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1002\/ijc.25555","article-title":"Optimizing targeted therapeutic development: Analysis of a colorectal cancer patient population with the BRAFV600E mutation","volume":"128","author":"Tie","year":"2011","journal-title":"Int. J. Cancer"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2425","DOI":"10.1056\/NEJMoa2501912","article-title":"Encorafenib, Cetuximab, and mFOLFOX6 in BRAF -Mutated Colorectal Cancer","volume":"392","author":"Elez","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Kopetz, S., Yoshino, T., Van Cutsem, E., Eng, C., Kim, T.W., Wasan, H.S., Desai, J., Ciardiello, F., Yaeger, R., and Maughan, T.S. (2025, January 23\u201325). BREAKWATER: Analysis of first-line encorafenib + cetuximab + chemotherapy in BRAF V600E-mutant metastatic colorectal cancer. Proceedings of the 2025 ASCO Gastrointestinal Cancers Symposium, San Francisco, CA, USA.","DOI":"10.1200\/JCO.2025.43.4_suppl.16"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1200\/JCO.2026.44.2_suppl.13","article-title":"BREAKWATER: Primary analysis of first-line (1L) encorafenib + cetuximab (EC) + FOLFIRI in BRAF V600E-mutant metastatic colorectal cancer (mCRC)","volume":"44","author":"Kopetz","year":"2026","journal-title":"J. Clin. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1158\/1078-0432.CCR-11-1469","article-title":"Molecular pathways: Microsatellite instability in colorectal cancer: Prognostic, predictive, and therapeutic implications","volume":"18","author":"Sinicrope","year":"2012","journal-title":"Clin. Cancer Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.1056\/NEJMoa2017699","article-title":"Pembrolizumab in Microsatellite-Instability\u2013High Advanced Colorectal Cancer","volume":"383","author":"Shiu","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/S1470-2045(21)00064-4","article-title":"Health-related quality of life in patients with microsatellite instability-high or mismatch repair deficient metastatic colorectal cancer treated with first-line pembrolizumab versus chemotherapy (KEYNOTE-177): An open-label, randomised, phase 3 trial","volume":"22","author":"Andre","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S0140-6736(24)02848-4","article-title":"Nivolumab plus ipilimumab versus nivolumab in microsatellite instability-high metastatic colorectal cancer (CheckMate 8HW): A randomised, open-label, phase 3 trial","volume":"405","author":"Elez","year":"2025","journal-title":"Lancet"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"5644","DOI":"10.1200\/JCO.2005.08.144","article-title":"Swedish rectal cancer trial: Long lasting benefits from radiotherapy on survival and local recurrence rate","volume":"23","author":"Folkesson","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"5124","DOI":"10.1200\/JCO.2009.22.0467","article-title":"Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03","volume":"27","author":"Roh","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1926","DOI":"10.1200\/JCO.2011.40.1836","article-title":"Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: Results of the German CAO\/ARO\/AIO-94 randomized phase III trial after a median follow-up of 11 years","volume":"30","author":"Sauer","year":"2012","journal-title":"J. Clin. Oncol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/S0140-6736(09)60484-0","article-title":"Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): A multicentre, randomised trial","volume":"373","author":"Stephens","year":"2009","journal-title":"Lancet"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/S1470-2045(11)70097-3","article-title":"Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial","volume":"12","author":"Marijnen","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_53","first-page":"CD002102","article-title":"Preoperative radiotherapy and curative surgery for the management of localised rectal carcinoma","volume":"10","author":"Abraha","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1001\/jama.284.8.1008","article-title":"Preoperative radiotherapy for resectable rectal cancer: A meta-analysis","volume":"284","author":"Camma","year":"2000","journal-title":"JAMA"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"4169","DOI":"10.1245\/s10434-013-3198-9","article-title":"Neoadjuvant radiotherapy for rectal cancer: Meta-analysis of randomized controlled trials","volume":"20","author":"Rahbari","year":"2013","journal-title":"Ann. Surg. Oncol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1097\/01.sla.0000257358.56863.ce","article-title":"The TME trial after a median follow-up of 6 years: Increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma","volume":"246","author":"Peeters","year":"2007","journal-title":"Ann. Surg."},{"key":"ref_57","first-page":"iv22","article-title":"Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"28","author":"Wyrwicz","year":"2017","journal-title":"Ann. Oncol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.prro.2020.08.004","article-title":"Radiation Therapy for Rectal Cancer: Executive Summary of an ASTRO Clinical Practice Guideline","volume":"11","author":"Wo","year":"2021","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1056\/NEJMoa2303269","article-title":"Preoperative Treatment of Locally Advanced Rectal Cancer","volume":"389","author":"Schrag","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"3724","DOI":"10.1200\/JCO.23.00903","article-title":"Patient-Reported Outcomes during and after Treatment for Locally Advanced Rectal Cancer in the PROSPECT Trial (Alliance N1048)","volume":"41","author":"Basch","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1097\/SLA.0000000000005780","article-title":"Neoadjuvant Chemotherapy with CAPOX Versus Chemoradiation for Locally Advanced Rectal Cancer with Uninvolved Mesorectal Fascia (CONVERT): Initial Results of a Phase III Trial","volume":"277","author":"Mei","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"S1267","DOI":"10.1016\/j.annonc.2023.10.018","article-title":"LBA26 Neoadjuvant chemotherapy with CAPOX versus chemoradiation for locally advanced rectal cancer with uninvolved mesorectal fascia (CONVERT): Final results of a phase III trial","volume":"34","author":"Ding","year":"2023","journal-title":"Ann. Oncol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"3223","DOI":"10.1200\/JCO.18.02309","article-title":"Neoadjuvant modified folfox6 with or without radiation versus fluorouracil plus radiation for locally advanced rectal cancer: Final results of the Chinese FOWARC trial","volume":"37","author":"Deng","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1200\/JCO-24-01676","article-title":"Neoadjuvant Modified Infusional Fluorouracil, Leucovorin, and Oxaliplatin with or Without Radiation Versus Fluorouracil Plus Radiation for Locally Advanced Rectal Cancer: Updated Results of the FOWARC Study After a Median Follow-Up of 10 Years","volume":"43","author":"Zhang","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"3355","DOI":"10.1200\/JCO.24.01160","article-title":"Management of Locally Advanced Rectal Cancer: ASCO Guideline","volume":"42","author":"Scott","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.prro.2024.11.003","article-title":"Radiation Therapy for Rectal Cancer: An ASTRO Clinical Practice Guideline Focused Update","volume":"15","author":"Wo","year":"2025","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1016\/j.annonc.2025.05.528","article-title":"Localised rectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up","volume":"36","author":"Hofheinz","year":"2025","journal-title":"Ann. Oncol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1097\/01.sla.0000141194.27992.32","article-title":"Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: Long-term results","volume":"240","author":"Perez","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"2537","DOI":"10.1016\/S0140-6736(18)31078-X","article-title":"Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): An international multicentre registry study","volume":"391","author":"Hilling","year":"2018","journal-title":"Lancet"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"2546","DOI":"10.1200\/JCO.22.00032","article-title":"Organ Preservation in Patients with Rectal Adenocarcinoma Treated with Total Neoadjuvant Therapy","volume":"40","author":"Patil","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e2350903","DOI":"10.1001\/jamanetworkopen.2023.50903","article-title":"Organ Preservation and Survival by Clinical Response Grade in Patients with Rectal Cancer Treated with Total Neoadjuvant Therapy A Secondary Analysis of the OPRA Randomized Clinical Trial","volume":"7","author":"Thompson","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Smith, J.J., Chow, O.S., Gollub, M.J., Nash, G.M., Temple, L.K., Weiser, M.R., Guillem, J.G., Paty, P.B., Avila, K., and Garcia-Aguilar, J. (2015). Organ Preservation in Rectal Adenocarcinoma: A phase II randomized controlled trial evaluating 3-year disease-free survival in patients with locally advanced rectal cancer treated with chemoradiation plus induction or consolidation chemotherapy, and total mesorectal excision or nonoperative management. BMC Cancer, 15.","DOI":"10.1186\/s12885-015-1632-z"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1200\/JCO.23.01208","article-title":"Long-Term Results of Organ Preservation in Patients with Rectal Adenocarcinoma Treated with Total Neoadjuvant Therapy: The Randomized Phase II OPRA Trial","volume":"42","author":"Verheij","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1097\/DCR.0000000000002494","article-title":"The Risk of Distant Metastases in Patients with Clinical Complete Response Managed by Watch and Wait after Neoadjuvant Therapy for Rectal Cancer: The Influence of Local Regrowth in the International Watch and Wait Database","volume":"66","author":"Fernandez","year":"2023","journal-title":"Dis. Colon Rectum"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"znae246","DOI":"10.1093\/bjs\/znae246","article-title":"Baseline MRI predictors of successful organ preservation in the Organ Preservation in Rectal Adenocarcinoma (OPRA) trial","volume":"111","author":"Williams","year":"2024","journal-title":"Br. J. Surg."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e232748","DOI":"10.1148\/radiol.232748","article-title":"MRI Predicts Residual Disease and Outcomes in Watch-and-Wait Patients with Rectal Cancer","volume":"312","author":"Williams","year":"2024","journal-title":"Radiology"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1097\/DCR.0000000000003096","article-title":"Endoscopic Predictors of Residual Tumor after Total Neoadjuvant Therapy: A Post Hoc Analysis from the Organ Preservation in Rectal Adenocarcinoma Trial","volume":"67","author":"Williams","year":"2024","journal-title":"Dis. Colon Rectum"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"5669","DOI":"10.1007\/s00464-025-11982-0","article-title":"The value of MRI and flexible sigmoidoscopy in detecting tumor regrowth in watch and wait rectal cancer patients undergoing active surveillance after total neoadjuvant therapy","volume":"39","author":"Yeung","year":"2025","journal-title":"Surg. Endosc."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1016\/j.annonc.2024.07.729","article-title":"Organ preservation after neoadjuvant long-course chemoradiotherapy versus short-course radiotherapy","volume":"35","author":"Bercz","year":"2024","journal-title":"Ann. Oncol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1093\/bjs\/znad051","article-title":"Watch and wait after neoadjuvant treatment in rectal cancer: Comparison of outcomes in patients with and without a complete response at first reassessment in the International Watch & Wait Database (IWWD)","volume":"110","author":"Temmink","year":"2023","journal-title":"Br. J. Surg."},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Williams, H., Lee, C., and Garcia-Aguilar, J. (2024). Nonoperative management of rectal cancer. Front. 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