The OPRA trial was a prospective, randomized, phase II trial published in 2022. We provided a step-by-step practical review of the WW approach. Clinicians willing to adopt the WW strategy in their routine practice should assimilate the detailed approach. In this article, we summarized the main clinical results of the WW approach. Growing evidence has indicated that the WW approach was a safe and effective option in patients who achieved excellent tumor response after neoadjuvant treatment. In the WW approach, patients with locally advanced rectal cancer who achieve excellent clinical response after neoadjuvant treatment undergo active surveillance rather than rectal surgery. The watch-and-wait (WW) approach is a noninvasive therapeutic alternative for organ preservation and avoiding operative morbidity. Accordingly, there has been a demand for omitting surgical resection in these patients. The excellent oncologic outcomes in patients who achieved pathologic complete response (CR) after neoadjuvant treatment questioned the need for radical resection surgery. In addition, patients with very low tumors undergo abdominoperineal resection, which results in permanent colostomy. ![]() ![]() Rectal surgery is associated with significant morbidity, such as poor body image and gastrointestinal, micturition, and sexual problems. However, functional outcomes and quality of life after radical resection remain suboptimal. Total mesorectal excision has been the mainstay of treatment of locally advanced rectal cancer. Neoadjuvant therapy-such as long-course chemoradiotherapy and short-course radiotherapy, surgical resection, and adjuvant chemotherapy-are conventional treatments of locally advanced rectal cancer.
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